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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). 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. The PLoS Medicine Editors. The impact factor game. PLoS Med 2006; 3: e291. 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. Bennett S, Green A, eds. Sound choices: enhancing capacity for evidence-informed health policy. Geneva: Alliance for Health Policy and Systems Research, 2007.

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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. 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). 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 are not new to Zimbabwe, the methodical and targeted brutality directed against political opposition during the past year is alarming. With upcoming elections scheduled for March 29, political violence will likely escalate. The international community and particularly the African community must do all that is possible to prevent torture and violence in Zimbabwe and to protect citizens, including health professionals, who assist victims of political violence. Political repression complicates and fuels the ongoing crisis in health and human rights in Zimbabwe. The country currently has among the highest infant mortality rate and the lowest life expectancy in the world1 in a backdrop of unemployment, empty shelves in shops, and 100 000% inflation.2 Political repression 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. After a peaceful prayer rally in March, 2007, there was an upsurge in political violence in Zimbabwe.4 Research from the Bellevue/NYU Program for Survivors of Torture5 and the South African non-governmental organisation, 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 with only peripheral involvement were deliberately
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targeted with a distressing increase in the incidence of attacks against women and in private homes. 80% of the 414 interviewees in Solidarity Peace Trust’s report had physical injuries with corroborating medical documentation.6 Researchers from the Bellevue/NYU Program for Survivors of Torture evaluated 24 people for gross evidence of physical and psychological abuse. We saw a variety of injuries: broken arms and ankles; scars from being repeatedly hit on the back, arms, and soles of feet; and gaping, open wounds from being kicked or shot. We also heard evidence of the psychological wounds: sleeplessness, weight loss, vigilance, tearfulness, nightmares, and hiding away to avoid further danger or risk putting others in danger. Targeted political violence has also disrupted the provision of legal and medical services. In interviews

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Nelson Chamisa, opposition spokesperson, in intensive care in Harare, Zimbabwe, 2007

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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 welldocumented 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

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 2 3 World Health Organization. World health report 2007:working together for health. Geneva: WHO, 2007. BBC News. Zimbabwe inflation hits 100 000. Feb 20, 2008. http://news. bbc.co.uk/2/hi/business/7255588.stm (accessed Feb 21, 2008). 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). Human Rights Watch. Bashing dissent: escalating violence and state repression in Zimbabwe. 2007. http://hrw.org/reports/2007/ zimbabwe0507/ (accessed Feb 13, 2008). 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). Solidarity Peace Trust. Destructive engagement: violence, mediation and politics in Zimbabwe. 2007. http://www.solidaritypeacetrust.org/reports/ destructive_engagement.pdf (accessed Feb 13, 2008). Pincock S. Douglas Gwatidzo: defending human rights in Zimbabwe. Lancet 2005; 366: 363. Front line. Ongoing harassment of human rights lawyers in Zimbabwe. http://www.frontlinedefenders.org/node/961 (accessed Feb 21, 2008). 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). 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). 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).

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