Susannah Sirkin, "one by One Makes a Bundle": Action Through Legal, Medical, and Public Health Partnering

• Citation: Vol. 22 No. 1
• Publication year: 2008

"ONE BY ONE MAKES A BUNDLE": ACTION THROUGH LEGAL, MEDICAL, AND PUBLIC HEALTH PARTNERING

Susannah Sirkin^*

It's truly an honor to be here in Atlanta at Emory. I tend to speak at schools of public health and medicine, less often at law schools. It's sometimes daunting for those of us who are non-lawyers to speak to groups of lawyers, but I have many friends here who are also in the health field. It's great to bring these two disciplines together.

There are a number of reasons that it's really special for me to be here. One of them is that when Physicians for Human Rights (PHR) was first founded twenty years ago this year,¹Jimmy Carter sent a very strong endorsement of the notion that there was a gap in the human rights community in the United States. There was truly a need for an organization that dealt with health and human rights, and this was a place for physicians and public health professionals of all sorts, nurses and others, to engage with one another.

Also, Dean James Curran here at the Emory School of Public Health has been a staunch ally and a mentor to us, especially in our work on HIV/AIDS. And Professor Berman. Personally, I encountered Professor Hal Berman when I was just out of college and moved to Cambridge. Although I didn't attend law school, I was very interested in Soviet issues-in fact, that's how I first got engaged in the human rights movement. I used to hear him lecture. It's a privilege and honor to stand before you.

Finally, when I started my job at Amnesty International U.S.A. in 1983, my first huge task was to organize Amnesty International's Annual General Meeting. It was a daunting task bringing together hundreds of activists, and that year, we convened at Emory. The subject of the conference was the launch of Amnesty International's campaign against political killings. We brought Rigoberta Menchú, a Guatemalan activist, who later won the Nobel

Prize.²She's currently a candidate for the head of state in Guatemala.³At that time, no one had ever heard of her.

Another guest was Kim Dae-jung of South Korea, who had just recently been released from prison and who later became a head of state.⁴I remember walking him through our exhibit here at Emory, the first photographic exhibit documenting the killing fields of Cambodia. Kim Dae-jung, who had been severely injured and was walking with a cane, stood in silence in front of each of the photographs and finally said, "I have long been an opponent of the death penalty, but I think I could have supported the execution of Pol Pot."

Those of us in Amnesty were advocating for the abolition of the death penalty in the United States, as we still are in the human rights movement here. It was really a profound experience, being at Emory on that occasion, and very moving.

So I'm back and it's great to be here.

This morning, we heard a fascinating lecture by David Fidler-challenging and provocative and deep. He announced that he was going to be the scoundrel, meaning that he was going to speak in generalizations. What I'm going to do is the opposite, but I'm not really quite sure what the opposite of "scoundrel" is. I suppose it could be "saint," though I would never claim or meet such a description. I'll just take the epithet of human rights advocate for my talk.

What I'm going to do is go right down to the ground, and in the course of doing so I hope to provide some practical answers to the questions we heard this morning.

Almost ten years ago, an extraordinary international convocation of people sat in a government building in Ottawa, Canada, to witness a landmark historical event. Heads of state and foreign ministers, the Secretaries General of the United Nations and of the International Committee of the Red Cross, dozens of grassroots activists, and leaders of nongovernmental organizations gathered.⁵We represented legal, medical, public health, development, religious, humanitarian, and human rights constituencies. Most importantly, we included people from dozens of mine-infested countries who represented hundreds of thousands of others who had literally marched and limped across their countries in an unprecedented campaign.

We were all there in Ottawa to watch and to celebrate the signing of the global treaty banning landmines.⁶A mere five years after a small group of six nongovernmental organizations had issued what we truly considered to be a pie-in-the-sky appeal for the elimination of this heinous weapon from the global arsenal-there we were, on the threshold of a new international norm.

In five years, six groups on two continents had become 2,000 groups on six continents. Armed with the grim data of injuries and deaths, especially to women and children, the harms to agriculture and economies, to refugee repatriation and development, the international campaigners shocked and prodded the world's conscience and re-galvanized support.

In only three years, from 1994 to 1997, a handful of government supporters grew to more than a hundred.⁷Amazingly toward the end, the issue was catapulted out of the phlegmatic business-as-usual debate in Geneva and whisked into a treaty process initiated by governments that cared and had the courage, the creativity, and the legal and moral certitude to launch this treaty.⁸

Even without the U.S., China, and Russia formally on board, this treaty has proven a phenomenal success in saving lives and preventing death and disability in dozens of countries. Unique among disarmament treaties and perhaps due to the engagement of health experts and people living in mine- infested areas, the treaty creates obligations for de-mining and prevention and for assistance to landmine survivors.⁹At that treaty signing, which I was so privileged to witness, governments put hundreds of millions of dollars on the table for those purposes as a result of the treaty. As one way to address the fact that they were not supporting this new international norm, non-signers like the United States also ponied up enormous amounts of money and announced that even though they weren't supporting a ban, at least in the form of this treaty, they were providing assistance.¹⁰

The U.S. has virtually complied with the treaty because the campaign has succeeded in making the use of landmines, to use Bill Foege's term from yesterday, "unconscionable." Just as important, though, this effort has created a framework, I think, and a model for global efforts to address many of the painful subjects we have discussed at this conference.

Now, stopping sexual violence or preventing maternal mortality is surely not the same as banning one weapon, much less the task we have of engaging in this global health anarchy that we heard about this morning. And yes, the data can be paralyzing-HIV/AIDS, malaria, TB, rape, maternal mortality, illiteracy, poverty, traffic accidents, many of which result from, or are exacerbated by, discrimination and inequalities. The growing gap that we heard about this morning from Professor Fidler between new norms and standards, which are very exciting, and their implementation on the ground in the least developed countries is also paralyzing. We've seen how deeply women's health is harmed by entrenched cultural, social, and religious traditions and practices-many of them fig leaves for male domination of women, which transcends all societies and cultures.

Laws alone, important as they are, will not solve the crisis in women's health or global health. But there are numerous lessons to be learned, I believe, from what is happening in small places near and far. Taking shape right now are major global initiatives to dramatically reduce maternal mortality and to stop rape in war, daunting as that sounds. Yesterday, we heard Mary

Robinson announce her new initiative, Women Won't Wait,¹¹which highlights violence against women and its direct link to sexually transmitted diseases, including HIV/AIDS, which is still a death sentence for millions. In the coming years, I think we will also see new efforts to send girls to school and keep them there. Some of these, I think, will take center stage.

These campaigns are already teaching some of the lessons that we learned from the International Campaign to Ban Landmines and from other successful human rights campaigns. Yes, most of these efforts deal with specific issues and mobilize specific coalitions that have common interests, or maybe they even have different interests and are able to coalesce around one key goal, but the end of the line, as we heard...