"We (still) charge genocide": A systematic review and synthesis of the direct and indirect health consequences of police violence in the United States.

Building on historical and contemporary efforts to eliminate police and other forms of state violence, and on the understanding that police violence is a social determinant of health, we conducted a systematic review in which we synthesize the existing literature around 1) racial disparities in police violence; 2) health impacts of direct exposure to police violence; and 3) health impacts of indirect exposure to police violence. We screened 336 studies and excluded 246, due to not meeting our inclusion criteria. Forty-eight additional studies were excluded during the full text review, resulting in a study sample size of 42 studies. Our review showed that Black people in the US are far more likely than white people to experience a range of forms of police violence: from fatal and nonfatal shootings, to assault and psychological violence. Exposure to police violence increases risk of multiple adverse health outcomes. Moreover, police violence may operate as a vicarious and ecological exposure, producing consequences beyond those directly assaulted. In order to successfully eliminate police violence, scholars must work in alignment with social justice movements.

Racismo e construção da carreira: estratégias de enfrentamento adotadas por universitários negros / Racism and career construction: coping strategies adopted by black undergraduates / Racismo y construcción de la carrera: estrategias de afrontamiento que utilizan los universitarios negros

O racismo é um fenômeno que impacta a vida da população negra, direcionando-a para uma condição de marginalização social, inclusive profissionalmente. Diante disso, o presente estudo, qualitativo, objetivou analisar as estratégias de enfrentamento ao racismo adotadas por universitários negros de uma instituição pública de ensino superior no processo de construção de suas carreiras. Adotando-se como referencial a Teoria de Construção da Carreira, 27 entrevistas semiestruturadas foram conduzidas com graduandos (16 do gênero feminino e 11 do gênero masculino) autodeclarados negros de uma universidade situada na região Sudeste do Brasil. Os dados coletados foram submetidos a Análise de Similitude, por meio do software IRaMuTeQ, que demonstrou, a partir de uma árvore máxima, que os discursos dos participantes estiveram centrados no termo "racismo" e em quatro troncos de similitude relacionados aos vocábulos: "negro", "falar", "situação" e "acontecer". Os resultados indicaram que o racismo é um dos fatores que impactam a carreira dos sujeitos, sobretudo por sustentar práticas discriminatórias veladas e limitar oportunidades profissionais. Em resposta a ele, quatro estratégias de enfrentamento foram identificadas: a) diálogo com sujeitos próximos; b) busca por suporte junto à rede de apoio constituída na universidade; c) denúncia de seus impactos; e d) adoção de ações individuais de transformação da realidade. Os achados permitem identificar a adoção de diferentes estratégias individuais e coletivas de enfrentamento ao racismo, que devem ter seu desenvolvimento estimulado pelas instituições de ensino superior, a fim de que se tornem práticas sistematizadas que favoreçam a discussão sobre o fenômeno em âmbitos acadêmico e profissional.(AU)

The phenomenon of racism impacts the lives of Black population, leading them to social marginalization, including professionally. Thus, this qualitative study analyzes the coping strategies adopted by Black undergraduates from a public higher education institution to confront racism during career construction. Adopting the Career Construction Theory as a framework, 27 semi-structured interviews were conducted (16 women and 11 men) with self-declared black undergraduates from a university located in southeastern Brazil. Similarity analysis of the collected data, performed using the IRaMuTeQ software, showed that, from a maximum tree, the participants' speeches centered around the term "racism" and on four similarity trunks related to the words: "black", "talk", "situation" and "happen". Results indicated that racism majorly impacts the subjects' careers, especially by upholding veiled discriminatory practices and limiting professional opportunities. To cope with it, undergraduates adopt four main strategies: a) dialogue with close subjects; b) search for support with the support network established at the university; c) denunciation of its impacts; and d) adoption of individual strategies to transform reality. The findings point to different actions, individual and collective, adopted to fight racism, whose development should be supported by higher education institutions so that they become systemic practices that favor discussing the phenomenon in academic and professional fields.(AU)

El racismo es un fenómeno que impacta la vida de la población negra, llevándola a una condición de marginación social, incluso a nivel profesional. Así, este estudio cualitativo, tuvo por objetivo analizar las estrategias de afrontamiento el racismo que utilizan los universitarios negros de una Institución Pública de Educación Superior en el proceso de construcción de sus carreras. Tomando como referencia la Teoría de Construcción de Carrera, se realizaron 27 entrevistas semiestructuradas a estudiantes (16 mujeres y 11 hombres) autodeclarados negros de una universidad en la región Sureste de Brasil. Los datos recolectados se sometieron a un Análisis de Similitud, desarrollado utilizando el software IRaMuTeQ, que demostró, a partir de un árbol máximo, que los discursos de los participantes se centraron en el término "racismo" y en cuatro troncos de similitud relacionados con las palabras: "negro", "hablar", "situación" y "pasar". Los resultados indicaron que el racismo es uno de los factores que impactan la carrera, especialmente por sostener prácticas discriminatorias veladas y limitar las oportunidades profesionales. En respuesta a ello, se identificaron cuatro estrategias de afrontamiento: a) diálogo con sujetos cercanos; b) búsqueda de apoyo en la red constituida en la universidad; c) denuncia de sus impactos; y d) adopción de acciones individuales para transformar la realidad. Los hallazgos permiten identificar la adopción de diferentes estrategias, individuales y colectivas, para enfrentar el racismo, las cuales deben tener su desarrollo estimulado por las instituciones de educación superior, para que se conviertan en prácticas sistematizadas que favorezcan la discusión del fenómeno en el ámbito académico y profesional.(AU)

A subtração da vida como política de morte: vozes de mães de jovens negros assassinados / The subtraction of life as a policy of death: voices of mothers of murdered young black people / La sustracción de vida como política de muerte: voces de madres de jóvenes negros asesinados

Objetivamos reconstruir, por meio das vozes de mães de jovens negros mortos em ações policiais, a subtração da vida de seus filhos em contínuas políticas que precarizavam suas existências ao negar-lhes direitos básicos e cidadania. Participaram desta pesquisa seis mães. As conversas com elas, após cuidadosa aproximação, se iniciaram com a pergunta disparadora: "Como você gostaria de contar a história do seu filho?". Para subsidiar nossas análises, tomamos como centrais a articulação teórica e política das noções de genocídio negro e de necropolítica. Este artigo evidencia que, entre o nascimento e a interrupção da vida por balas que atravessam o corpo como um alvo predestinado, o racismo constrói trilhos de precarização da vida que a torna cada vez mais abjeta, vulnerável e descartável, conduzindo à morte precoce, ainda que preveníveis, de jovens negros, principalmente, residentes em periferias e favelas. Nesta discussão, fomentamos uma visão menos compartimentalizada das múltiplas políticas genocidas, trazendo para o diálogo outras políticas públicas, para além da segurança pública. Abordamos um continuum de produção e legitimação de mortes de jovens negros, centrando nossas análises nas formas de apagamento social e institucional desses jovens, que ocorreram anteriormente à morte física, de modo a desqualificar suas vidas. Esses processos contribuem para que a política de segurança pública extermine vidas de jovens negros sem causar ampla comoção social, a devida investigação criminal e, portanto, a responsabilização do Estado, pois já eram vidas mutiladas e desumanizadas em suas existências.(AU)

We aim to reconstruct, with the voices of mothers of young black people killed in police actions, the subtraction of their children's lives in continuous policies that undermined their existence by denying them basic rights and citizenship. Six mothers participated in this research. The conversations with them, after a careful approach, began with the triggering question: "How would you like to tell your child's story?". To support our analyses, we take as central the theoretical and political articulation of the notions of black genocide and necropolitics. This article shows that, between the birth and the interruption of life by bullets that pass through the body as a predestined target, racism builds trails of precariousness of life that makes it increasingly more abject, vulnerable, and disposable, leading to premature death, even if preventable, of young black people, mainly, living in suburbs and slums. In this discussion, we foster a less compartmentalized view of multiple genocidal policies, bringing to the dialogue other public policies, in addition to public safety. We approach a continuum of production and legitimization of deaths of young black people, centering our analysis on the forms of social and institutional erasure of these young people, which occurred before physical death, to disqualify their lives. These processes contribute to the public security policy to exterminate the lives of young black people without causing widespread social upheaval, due criminal investigation, and, thus, the accountability of the State, since they were already mutilated and dehumanized lives in their existence.(AU)

El objetivo de este artículo es reconstruir, a través de las voces de las madres de jóvenes negros asesinados en acciones policiales, la sustracción de la vida de sus hijos en políticas continuas que socavaron su existencia al negarles derechos básicos y ciudadanía. Seis madres participaron en esta investigación. Las conversaciones con estas madres, después de un enfoque cuidadoso, comenzaron con la pregunta desencadenante: "¿Cómo le gustaría contar la historia de su hijo?". Para apoyar el análisis, se tomó como eje central la articulación teórica y política de las nociones de genocidio negro y necropolítica. Este artículo muestra que, entre el nacimiento y la interrupción de la vida por balas que atraviesan el cuerpo como fin predestinado, el racismo construye senderos de precariedad de la vida que la hace cada vez más abyecta, vulnerable y desechable, conduciendo a una muerte prematura, incluso prevenible, de jóvenes negros, principalmente, residentes en la periferia y favelas. Esta discusión fomenta una visión menos compartimentada de múltiples políticas genocidas, llevando al diálogo otras políticas públicas, además de la seguridad pública. Se acerca a un continuo de producción y legitimación de muertes de jóvenes negros, centrando el análisis en las formas de borrado social e institucional de estos jóvenes, ocurridas antes de la muerte física, para descalificar sus vidas. Tales procesos contribuyen a la política de seguridad pública para exterminar la vida de los jóvenes negros sin provocar un gran revuelo social, la debida investigación criminal y, en consecuencia, la rendición de cuentas del Estado, pues ya eran vidas cuya existencia era mutilada y deshumanizada.(AU)

Canada's Colonial Genocide of Indigenous Peoples: A Review of the Psychosocial and Neurobiological Processes Linking Trauma and Intergenerational Outcomes.

The policies and actions that were enacted to colonize Indigenous Peoples in Canada have been described as constituting cultural genocide. When one considers the long-term consequences from the perspective of the social and environmental determinants of health framework, the impacts of such policies on the physical and mental health of Indigenous Peoples go well beyond cultural loss. This paper addresses the impacts of key historical and current Canadian federal policies in relation to the health and well-being of Indigenous Peoples. Far from constituting a mere lesson in history, the connections between colonialist policies and actions on present-day outcomes are evaluated in terms of transgenerational and intergenerational transmission processes, including psychosocial, developmental, environmental, and neurobiological mechanisms and trauma responses. In addition, while colonialist policies have created adverse living conditions for Indigenous Peoples, resilience and the perseverance of many aspects of culture may be maintained through intergenerational processes.

Transgenerational Trauma and Mental Health Needs among Armenian Genocide Descendants.

The trauma of a genocide can be transmitted to subsequent generations though familial mental health, sociopolitical trauma, and cultural narratives, thereby impacting mental health and well-being. Understanding specific mechanisms that are unique to each ethnic group impacted by genocide illuminates cultural, sociopolitical, and individual factors related to the transmission. For the Armenian community, the unresolved historical loss of the Armenian Genocide of 1915, with the threat of acculturation for such a large diasporic population, a continued denial by the perpetrators, as well as subsequent generations' refugee experiences, may further exasperate the impact of transgenerational trauma from the genocide. This literature review explores the mental health needs of Armenian youth in the current sociopolitical context and provides implications for how schools and communities may use this knowledge to inform supports that center Armenian community healing. Future directions for research are also discussed.

Mulheres negras e Necropolítica: como enfrentam a morte de seus filhos? / Black women and Necropolitics: how they face the death of their children?

OBJETIVO: A morte de jovens negros é o principal resultado da violência urbana. Quando esses jovens morrem deixam os seus familiares, principalmente as mães negras, em um contexto de sofrimento causado por essa perda. Nesse contexto, as mulheres negras desenvolvem formas de enfrentamento para lidar com a dor. OBJETIVO: Analisar formas de enfrentamento de mulheres negras diante do assassinato de seus filhos na capital baiana. MÉTODO: Trata-se de uma pesquisa qualitativa, do tipo documental, realizada em sites que publicaram relatos dessas mulheres entre 2014 a 2019. Os dados foram analisados a partir da análise de conteúdo, com fundamento em Minayo. Para a realização da pesquisa, fez-se o uso de documentos públicos e de acesso livre. RESULTADOS: Foram mapeados oito relatos de mães negras, sendo sete oriundos de jornais online e um em blog. Seus relatos revelam muito sofrimento psíquico, e desvelam contextos marcados por racismo, violências e violação de direitos. Nesse cenário emergiram algumas formas de enfrentamentos como a religiosidade, a busca por justiça e a percepção das mães negras diante do racismo. CONSIDERAÇÕES: Foi possível conhecer a caminhada dessas mulheres que foram atravessadas pela violência e que a partir disso construíram formas de enfrentamento e cuidado. Os resultados apontam para maior necessidade de pesquisas que investiguem mais sobre esse sofrimento e seus desdobramentos na saúde mental dessas mães.

OBJECTIVE: The death of young black people is the main result of urban violence. When these young people die they leave their families, especially black mothers who needs to deal with the pain. OBJECTIVE: To analyze ways of confronting black women in the face of the murder of their children in Salvador. METHOD: This is a qualitative documentary research carried out on websites that published reports of these women between 2014 and 2019. The data were analyzed from content analysis, based on Minayo.To carry out the research, public documents and free access were used. RESULTS: Eight reports of black mothers were mapped, seven from online newspapers and one from blog. These reports reveal much psychic suffering, and reveal contexts marked by racism, violence and violation of rights. In this scenario, some forms of confrontations emerged, such as religiosity, the search for justice and the perception of black mothers in the face of racism. CONSIDERATIONS: It was possible to know the walk of these women who were crossed by violence and and that from this they built ways of coping and care. The results point to a greater need for research that investigates more about this suffering and its consequences in the mental health of these mothers.

The psychological correlates of transitional justice in Rwanda: A long-term assessment.

OBJECTIVE: We tested the psychological correlates of the Gacaca tribunals, a massive program of transitional justice put in place by the Rwandan government following the 1994 genocide perpetrated against the Tutsi. METHOD: The sample consisted of 679 Rwandese participants, among which 373 (55%) were survivors of the genocide. We contrasted three groups of participants: (1) those who had never attended the Gacaca (N = 229), the control group, (2) those who had attended without testifying (N = 275), the attendance group, and (3) those who had attended and testified (N = 120), the testimony group. In the analyses, we controlled for the level of genocide-related negative consequences that participants reported. RESULTS: The attendance group presented lower levels of PTSD and depression symptoms than both the control and testimony groups. Both attendance and testimony groups had more positive opinions of the Gacaca and higher openness to reconciliation than the control group. CONCLUSIONS: contrary to what has been reported in two previous studies, participation in the Gacaca was not, in our data, negatively related to mental health or to social cohesion. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Health ethics and Indigenous ethnocide.

In colonial societies such as Canada the implications of colonialism and ethnocide (or cultural genocide) for ethical decision-making are ill-understood yet have profound implications in health ethics and other spheres. They combine to shape racism in health care in ways, sometimes obvious, more often subtle, that are inadequately understood and often wholly unnoticed. Along with overt experiences of interpersonal racism, Indigenous people with health care needs are confronted by systemic racism in the shaping of institutional structures, hospital policies and in resource allocation decisions. Above all, racism is a function of state law - of the unilateral imposition of the settler society law on Indigenous communities. Indeed, the laws, including health laws, are social determinants of the ill-health of Indigenous peoples. This article describes the problem of Indigenous ethnocide and explores its ethical implications. It thereby problematizes the role of law in health ethics.

Mothers of children born of genocidal rape in Rwanda: Implications for mental health, well-being and psycho-social support interventions.

We explored the reality of mothers of children born of rape during the Rwandan genocide, particularly as it related to psychological well-being, stigma, recovery, and discussed relevant issues for mental health and psycho-social support interventions. Forty-four mothers participated in semi-structured qualitative interviews. Participants reported long-term psychological impacts resulting from sexual violence. Stigmatization and rejection from family and community aggravated psychological distress and affected their capacity to recover. Given participants' demonstrated capacity to overcome adversity, culturally appropriate mental health interventions are needed to promote well-being and social reintegration of mothers who bore children born of rape, while reducing stigmatization.

Medical mistrust in the context of Ebola: Implications for intended care-seeking and quarantine policy support in the United States.

This investigation explores Ebola conspiracy beliefs, a form of medical mistrust, and their potential impact on health behavior. Results of an online survey in the United States in December 2014 demonstrated that 16 percent of 202 participants held conspiracy beliefs. Participants who were less knowledgeable about Ebola, more mistrustful of medical organizations, and more xenophobic more strongly endorsed conspiracy beliefs. Participants who more strongly endorsed conspiracy beliefs reported that they would be less likely to seek care for Ebola and were less supportive of quarantining people returning from West Africa. Results suggest that medical mistrust may influence health behaviors during infectious disease outbreaks.

Silvia Rivadera, la huella de una colega desaparecida en la última dictadura argentina: Aportes a la memoria y a la perspectiva histórica­ ética-política de la terapia ocupacional / Silvia Rivadera, the imprint of a colleague who disappeared in the last argentine dictatorship: contributions to memory ano to the historical, ethicaland political perspective of occupational therapy

Silvia Juana Rivadero González fue una terapista ocupacional y militante del Partido Revolucionario de los Trabajadores y del Ejército Revolucionario del Pueblo desaparecida en lo último dictadura cívico eclesiástica militar de la Argentino (1976-1983). El artículo propone recuperar su historia y, a partir de ella,contribuir al debate para pensarlos representaciones sociales de la Terapia Ocupacional y el ejercicio profesional como un campo específico de acción político y una forma de favorecer lo accesibilidad y lo equidad en salud Se distingue así o la práctico profesional como un acto crítico, creador y transformador, atravesado por lo defensa de los Derechos Humanos en los diferentes realídades sociales, económicas, políticas y culturales. El trabajo sobre la memoria en la profesión nos sitúa en un presente que contiene y construye la experiencia pasada y las expectativas futuras. Visibilizar y abordar el impacto de la dictadura en los estudiantes y colegas,y las huellas que éstos dejaron, ha sido hasta el momento un comino poco explorado en nuestra disciplina. Se trata de un artículo de modalidad libre que se basó en la entrevisto a la hermana de nuestro colega quien nos transmitió su historia.

Silvia Juana Rivadera González was an occupational therapist and militant of the Partido Revolucionario de los Trabajadores and Ejército Revolucionario del Pueblo who disappeared in the last military ecclesiastical civic dictatorship of Argentina (1976-1983). The article proposes to recover her history and from it,to open a debate to think about the social representations of Occupational Therapy and the professional exercise as o specific field of political action and a way to promote accessibility and equity in health. Professional practice is thus defined as a critical creative and transformative act crossed by the defense of human rights in the different social economic, political and cultural realities. The work on memory of the profession places us in a present that contains and builds past experience and future expectations. To make visible and address the impact of the military ecclesiastical civic dictatorship on students and colleagues; and the troces left by them has so for been a path little explored in our discipline. This is a free article based on the interview to the sister of our disapeared colleague who transmitted her story.

Rehabilitation for Survivors of the 1994 Genocide in Rwanda: What Are the Lessons Learned?

Rehabilitation remains a significant concern among survivors of the 1994 genocide in Rwanda. Rehabilitation falls under tertiary prevention, which is a core function of public health. Despite efforts to introduce various rehabilitation programmes for genocide survivors in Rwanda, these initiatives have often proved inadequate in meeting their long-term needs. The failure of the Rwandan Government, international community, United Nations, and other Non-Government Organisations (NGOs) calls into serious question their commitment to international human rights laws. Rehabilitation should be regarded as a free-standing human right for genocide survivors and a human rights-based approach to the rehabilitative process should incorporate measurable outcomes based on an agreed ethical framework. The author calls upon the international community to reiterate its concerns about genocide survivors and reaffirm its commitments to human rights. The main issues discussed in this article are: the long-term needs of survivors of the 1994 genocide; what is already provided, and the gaps; how Stucki's Rehabilitation Cycle framework (a problem-solving tool) can help improve current provision; the role of the international community, NGOs, and genocide survivors' organisations in advancing rehabilitation; and the need for a human rights-based approach to rehabilitation. A strong recognition of the right to rehabilitation is crucial. An ethical framework related to the human rights-based approach should also assist in setting outcomes that can be measured against agreed standards, ensuring: rights that have been violated are identified; the accountability of each service provider in promoting rehabilitation; rehabilitation which is inclusive and non-discriminatory; participation by encouraging collaboration with survivors rather than doing things for them; and empowerment by enabling survivors to understand their rights and have the confidence to challenge or question when their rights have been violated.

Risk factors for homicide victimization in post-genocide Rwanda: a population -based case- control study.

BACKGROUND: Homicide is one of the leading causes of mortality in the World. Homicide risk factors vary significantly between countries and regions. In Rwanda, data on homicide victimization is unreliable because no standardized surveillance system exists. This study was undertaken to identify the risk factors for homicide victimization in Rwanda with particular attention on the latent effects of the 1994 genocide. METHODS: A population-based matched case-control study was conducted, with subjects enrolled prospectively from May 2011 to May 2013. Cases of homicide victimization were identified via police reports, and crime details were provided by law enforcement agencies. Three controls were matched to each case by sex, 5-year age group and village of residence. Socioeconomic and personal background data, including genocide exposure, were provided via interview of a family member or through village administrators. Conditional logistic regression, stratified by gender status, was used to identify risk factors for homicide victimization. RESULTS: During the study period, 156 homicide victims were enrolled, of which 57 % were male and 43 % were female. The most common mechanisms of death were wounds inflicted by sharp instruments (knives or machetes; 41 %) followed by blunt force injuries (36.5 %). Final models indicated that risk of homicide victimhood increased with victim alcohol drinking patterns. There was a dose response noted for alcohol use: for minimal drinking versus none, adjusted odds ratio (aOR) = 3.1, 95%CI: 1,3-7.9; for moderate drinking versus none, aOR = 10.1, 95%CI: 3.7-24.9; and for heavy drinking versus none, aOR = 11.5, 95%CI: 3.6-36.8. Additionally, having no surviving parent (aOR = 2.7, 95%CI: 1.1-6.1), previous physical and/or sexual abuse (aOR = 28.1, 95%CI: 5.1-28.3) and drinking illicit brew and/or drug use (aOR = 7.7, 95%CI: 2.4-18.6) were associated with a higher risk of being killed. The test of interaction revealed that the variables that were significantly associated with a higher risk of homicide victimhood, did not exhibit any difference according to sex of the victim. However, the effect of belonging to a religion differed between women and men, but was significantly protective for both (aOR = 0.002, 95%CI: 0.001-0.054 and aOR = 0.20, 95%CI: 0.052-0.509, respectively). CONCLUSION: Homicide victims in Rwanda are relatively young and the proportion of female victims is one of the highest globally. Contrary to the initial study considerations, genocide exposure (either as a survivor or perpetrator) was not a significant predictor of homicide victimization. Rather, risk factors were similar to those described in other countries, regardless of gender status. Sensitizing communities against alcohol heavy drinking, and illicit brew drinking and/or drug abuse and physical or sexual violence could reduce the homicide rate in Rwanda.

Trends and social differentials in child mortality in Rwanda 1990-2010: results from three demographic and health surveys.

BACKGROUND: Rwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010. METHODS: We performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15-49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method. RESULTS: Mortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005-2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR. CONCLUSIONS: Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths.

Building clinical trial priorities at the University of Rwanda.

After the genocide in Rwanda, the country's healthcare system collapsed. Remarkable gains have since been made by the state to provide greater clinical service capacity and expand health policies that are grounded on locally relevant evidence. This commentary explores the challenges faced by Rwanda in building an infrastructure for clinical trials. Through local examples, we discuss how a clinical trial infrastructure can be constructed by (1) building educational capacity; (2) encouraging the testing of relevant interventions using appropriate and cost-effective designs; and, (3) promoting ethical and regulatory standards. The future is bright for clinical research in Rwanda and with a renewed appetite for locally generated evidence it is necessary that we discuss the challenges and opportunities in drawing up a clinical trials agenda.