Following the unspeakable and unimaginable horrors of the Holocaust, the United Nations and the international community ratified the Genocide Convention and vowed “never again.” Over the past 70 years, however, the world has repeatedly broken this vow. Bosnia, Rwanda, Darfur, and others led Samantha Power, US ambassador to the UN, to suggest that a more apt phrase would be “again and again.”
It is through this lens that the international community must regard the violence currently unfolding in the Philippines. In the months since the election of Rodrigo Duterte this May, over 4,000 people have been killed for allegedly taking part in the drug trade. These extrajudicial killings are terrifying, but equally scary is the flippantly unapologetic attitude of Duterte. He likens himself to Hitler and has publicly stated he would be happy to slaughter millions of drug addicts. Those living in Manila are quickly becoming familiar with slain and duct-taped bodies appearing on neighborhood street corners. Often, the only explanation for the murder is a cardboard sign tacked to the chest of the victim with the words: ”I’m a pusher.”
Until recently, the international community has treated Duterte more as a bizarre oddity than legitimate threat to the human rights of his citizens. This leads us to question—where is the global condemnation? Where are the promises of legal action from international institutions, foreign governments, and advocacy groups?
Perhaps one reason the international response has been so anemic has to do with the way we classify Duterte’s victims. The widely accepted definition of genocide appears in Article 2 of the United Nations Convention on the Prevention and Punishment of the Crime of Genocide: “Acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group.” Drug addicts would at first glance not seem to fall under this umbrella. And yet, Duterte’s actions are clearly driven by a desire to destroy and eradicate an identifiable group of people. As the intent and consequences are the same, the tragedy unfolding in the Philippines should be treated as genocide.
The fact that such heinous crimes are not explicitly defined under international law is evidence that a larger problem looms, as well—the systematic devaluing of the rights of those who suffer from mental illnesses, including drug addiction. As doctors, we have witnessed first hand the way discriminating against a diseased group causes further emotional trauma, injury, and death. In this case, the mischaracterization of addiction in the Philippines is leading directly to violence, and murder. The effects of this stigmatization may last decades and, by spreading the notion that addicts are less than human, may affect those well beyond the Philippines.
Unfortunately, discrimination against the mentally ill is not a new phenomenon. In the Philippines, this discrimination is able to thrive in part because of the total lack of resources and education available. According to the World Health Organization, only 5% of the Philippines’ national health care expenditures are spent on mental health, and there are only 4 psychiatrists per 1,000,000 inhabitants. For comparison, there are 124 psychiatrists per 1,000,000 people in the United States— and nearly 300 in Norway.
In terms of rehabilitation services, there are a total of 44 treatment centers public and private treatment centers, with a combined capacity of just 7,200. This, in a country home to anywhere from 1.8 million to 3.7 million addicts. Even if government officials wanted to help, rather than harm, those with addiction, their efforts would be grossly under-resourced.
On the other hand, the Philippines is one of the largest recipients of development assistance from the United States in the Asia-Pacific region. In 2015, it received roughly $175 million in assistance in 2015. This provides the US with an important opportunity. Congress needs to cut off the millions of American taxpayer dollars it is currently funneling into the government of a volatile and murderous dictator. Preferably, some of the funding could be redirected toward rehabilitation facilities and health workforce training.
But individuals must make their own voices heard as well. Duterte carries one of the greatest net approval ratings of any presidency since the 1980s; an overwhelming majority of the Filipino people approve of his war on drugs. This could not be more misguided. As physicians, it is our explicit duty to advocate for the rights of the most vulnerable among us. There are also nearly four million Filipino Americans in the United States, many of whom are health care professionals. As their friends and families may be directly affected by Duterte’s violence, we believe the Filipino-American population can also be a loud voice for stronger human rights protections.
And we, like the State Department and Congress, must also talk with our money. One factor that eventually led to the toppling of the apartheid regime in South Africa was the United Nations’ request that member states boycott cultural, academic, and sporting engagements involving South Africa. On Nov. 5, boxing champion Manny Pacquiao—one of Duterte’s most ardent supporters in the Philippine’s Senate—took on Jesse Vargas in Las Vegas. On top of those who watched the fight in person, close to 300,000 people paid money to follow the match on pay-per-view. Pacquiao has said that Duterte was anointed by God to discipline the Filipino people. Sports fans could boycatt his matches, thereby sending a message to Duterte’s other defenders and apologists.
The past is littered with instances of protest that came far too late to stop crimes against humanity. This is especially true now, as global authoritarianism appears to be on the rise again. We cannot let Duterte attempt to disguise his genocidal intentions through stigmatizing rhetoric and blatant victim blaming. If allowed to continue unchecked, the results of this charade will last far longer than his tenure in office. Addiction is a disease, and addicts deserve treatment, not bullets. Now, before it is too late, we need to remember that “never again” is much more than an empty promise.