Editorial

1184 www.thelancet.com Vol 383 April 5, 2014

For The Lancet’s Editorial see Lancet 2008; 371: 1

For the report from Amnesty International see https://www.

amnesty.org.uk/sites/default/fi les/amnesty_death_penalty_

report_2014_fi nal.pdf

For more about the Egyptian trial see http://www.bbc.co.uk/news/

world-middle-east-26726901

On Jan 5, 2008, The Lancet published an Editorial to mark the UN’s moratorium of the death penalty. We noted that the US state of New Jersey had recently suspended all executions, several countries seemed likely to follow suit, and hopes were high that the practice would soon be consigned to “the dustbin of history”. Which is why Amnesty International’s report Death Sentences and Executions 2013, published on March 27, noting a 14% increase in executions in 2013, is of particular concern.

Overall, the worldwide trend for abolition continues. Rates of executions have decreased steadily in the past decade. No executions occurred in Europe and Central Asia or in 173 UN member states worldwide. In the USA, as evidence accumulates for racial disparities, miscarriages of justice, and the sentencing of several people who had mental illness, four states have stopped the death penalty since 2008, most recently Maryland in 2013.

Despite these positive signs, at least 778 people were executed in 2013, 96 more than in 2012, a rise

driven mainly by increases in Iran and Iraq. The number of death sentences given out also increased by 10% worldwide. Indonesia, Kuwait, Nigeria, and Vietnam resumed executions after none were recorded for up to 8 years. China is highly secretive about its use of capital punishment, but Amnesty International estimates that it executes thousands of people every year. And on March 24, an Egyptian court defi antly sentenced 528 people to death—the trial lasted 1 hour, and three-quarters of defendants were not present.

As a fi rst step towards abolition, greater transparency is needed, particularly from China and countries in the Arab world. An EU restriction of exports of sodium thiopental is thought to have hindered executions by lethal injection in the USA and Vietnam. Lawful eff orts by the medical community to obstruct capital punishment should be supported. At least 23 392 people were living with a death sentence at the end of 2013. The death penalty is an outmoded practice and focus should be on its eradication. The Lancet

Condemning the death penalty

Rwanda: looking to the futureTwo decades ago, Rwanda lay in ruins following the brutal genocide against the Tutsis. The scars of the massacre seemed too deep to heal for some observers at the time. But, in what has been described as the Rwanda miracle, the country turned its situation around. Today, ahead of the International Day of Refl ection on the Genocide in Rwanda on April 7, we publish online fi rst a Public Health paper by Rwanda’s minister of health Agnes Binagwaho and colleagues, which charts the extraordinary transformation of the country’s health system over the past 20 years.

Several factors were crucial to the country’s success including governmental leadership, a national development plan that championed health equity, a constitution that formalised the right to health, a community-based national health insurance system, training of community health workers, increases in foreign and domestic spending on health, and successful collaboration with international development partners.

The results have been impressive. Antiretroviral therapy (ART) has been rapidly scaled up and AIDS-related mortality fell by 82% between 2000 and 2012.

ART programmes have been used to strengthen primary health care and deliver other health services. Now, more than 97% of Rwandan infants are immunised against ten diff erent diseases and the country is on track to meet the health-related Millennium Development Goals.

These achievements are a credit to President Paul Kagame’s government and deserve to be celebrated. However, several unresolved issues could undermine the country’s continued progress. Kagame’s party has been in power for 20 years. Increasingly, concerns have been raised about political repression and human rights abuses by the regime to maintain its rule. The Rwandan regime also stands accused of fuelling the ongoing confl ict in neighbouring DR Congo. These activities pose a risk to the sustainability of the country’s health and developmental achievements, and to the wellbeing of people in the Great Lakes region. Rwanda has achieved great successes and can look forward, thanks to remarkable leadership, to continued rewards for the health of its people—its respect for democracy, human rights, and regional stability will be crucial to its future. The Lancet

See Public Health Lancet 2014; published online April 4.

http://dx.doi.org/10.1016/S0140-6736(14)60574-2

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