Tag: RHU

Book Review: The End of Violence

June 6, 2026.     Dr. Gary Slutkin, in his new book The End of Violence  (published April 21, 2026), explains his early career experience working with the Somali Refugee Health Unit, helping malnourished refugees in East Africa, which inspired him in time to apply the skills he learned to take on global outbreaks of violence, which can lead to malnutrition and famine.

An epidemiologist, Slutkin has applied the tools and lessons of disease prevention to violence across the U.S. and in other countries.  The End of Violence:  Eliminating the World’s Deadliest Epidemic (Little, Brown and Company)  sums up his insights and experiences over several decades, particularly in Chicago, Illinois, including his key insight that violence is contagious.  He writes: “Violence is often regarded as an unavoidable fact of life… [but it] enters the brain and infects people, communities, and countries via the same process as other epidemics.”

Over several decades of pioneering fieldwork, Slutkin observed that violence is not primarily a moral failing, or a political inevitability arising from poverty, or about failures of policing. 

Instead, violence is a contagious, communicable disease that alters human brain biology, spreads by person-to-person transmission, and can be contained using the standard public health epidemic playbook that he had previously used to fight TB, AIDS, and other diseases.  He notes the threat of super-spreaders, such as authoritarian leaders who abuse their platforms to mass-infect populations with violent ideologies or behaviors.

Slutkin finds that transmission is “dose dependent:”  “Children who were exposed to intermediate or high levels of violence, especially those who experienced chronic exposure, were over 3,000 percent or 31.5 times more likely to engage in chronic violent behavior than those who were exposed to no or low amounts of violence.”

Violence not only directly hurts people; it has indirect harms.  For example, when there is violence in communities, it prevents student learning and discourages teachers.

“We already have the tools to protect ourselves, heal our communities, and end violence in our lifetime. It is now up to us to use them.”

He argues that the cutting edge of public health is prevention via interaction with people to move them away from heighted risks.

Slutkin’s program trains “violence interrupters” and credible messengers (often individuals who have transformed their own lives after involvement in street violence) to identify and mediate conflicts before they turn lethal (the rough health equivalent of contact tracing and quarantine).

“To interrupt the transmission… we need to follow a new playbook, one grounded in public health… our most formidable tool to limit spreading is helping a population adopt safer behaviors…  There is no epidemic control without changes in behavior.”

Dr. Ron Waldman, who worked with him in Somalia, writes: “Slutkin has taken incredibly innovative thinking, adapted from his experiences in global health, and applied it with remarkable dedication and even more remarkable results, to one of the most enduring and destructive social problems plaguing the U.S.  This is an important book.”

His program, formerly called Ceasefire, now “Cure Violence Global” (CVG), has been replicated in hundreds of communities across 17 countries, and major cities in the United States.  These includes:

  • *  West Garfield Park, Chicago, where deaths dropped by 31.4% in the first year;
  • *  San Pedro Sula, Honduras, where shootings declined by 94%;
  • *  South Bronx, East New York, Brooklyn;
  • *  Port of Spain / Trinidad and Tobago; and
  • *  Cali, Colombia, where 30-50% of homicides were reduced.

Dr. Manuel Carballo, who has worked with him for many years, says:  “Dr Gary Slutkin’s work to prevent violence has not only reminded us of the magnitude of this global problem, but more importantly has explored the complex of factors that contribute to what he has so rightly and innovatively defined as a communicable disease. His work and his book is a game changer. It reflects a social tragedy that is all too often taken for granted or that generates responses that simply skim over the insidious character of the problem. The insights he provides should now serve as a guide for policy makers and the public at large, and hopefully will lead to new and concerted action. Dr Slutkin has pioneered a whole new public health arena and has been able to demonstrate that the incidence of violent behaviour can be effectively reduced. The implications of this for public health and human security are far-reaching.”

CVG is a nonprofit that provides training, technical assistance, assessment, capacity building, hiring support, monitoring, and ongoing guidance rather than directly running every local program. Local community-based organizations or governments usually implement the on-the-ground work (violence interrupters, outreach workers, etc.).

Slutkin writes, “We needed locals who had firsthand experience with violence.  …This was equally true in the epidemic work I did… If we wanted to reach Somali refugees, we needed to hire other Somali refugees.  If [we] wanted to help change behavior among intravenous drug users, [we] needed to hire former intravenous drug users.  People trust people they recognize themselves in, and, ideally, already know.”

In his concluding Action Plan, he recommends:  “Every city and community needs a violence-prevenion program, just as it needs police departments, fire departments, schools and health services.”

The books end-notes and “Solutions by Violence Syndrome Annex alone are worth the price of the book’s purchase.

The dominant funding source for CVG has been municipal and state government budgets, increasingly treating the program as recurring line items rather than one-off grants. Baltimore’s Safe Streets, for instance, became part of the city’s budget; NYC’s tens of millions flow through the city’s Crisis Management System; St. Louis committed multi-year city money through its Board of Aldermen.

Local health departments frequently act as the fiscal intermediary.  Private donors also make a difference, such as Bader Philanthropies, which gave $100,000 to the City of Milwaukee to implement Ceasefire.  Other funders are the Robert Wood Johnson Foundation, and the MacArthur Foundation.  International work has involved the World Bank and Inter-American Development Bank.

Over the years, institutions like the Department of Justice, Johns Hopkins University, and the Centers for Disease Control and Prevention (CDC) have evaluated these interventions, frequently validating significant statistical associations between Cure Violence implementation and reduced violence rates.

The program is cost-efficient.  Costs of implementation have varied from site to site, from $80,000 for a one-year startup, to $64 million in New York City.  Societal savings of CVG are often estimated at $7–$33+ per $1 invested due to reduced medical, criminal justice, and other costs.

The strongest evidence comes from quasi-experimental evaluations: difference-in-differences, synthetic controls, interrupted time series, comparison neighborhoods, before/after analyses, and mixed-methods evaluations. The 2025 systematic review identified 13 papers, covering 27 program sites and 83 findings on shootings or killings. Overall, two thirds of findings showed reductions. Outside Baltimore, 95.8% of sites showed reductions and 54.2% reached statistical significance. Hunger Notes generated CVG’s Theory of Change diagram, shown here.

While the CVG has been effective at local gun violence at the community level the evidence is less compelling for larger systematic political violence, state violence, civil war, and international war.

The Nobel Peace Prize committee should consider Slutkin for candidacy.

See also:  TED Talk  “Let’s treat violence like a contagious disease”

See:  GarySlutkin.com

  https://www.youtube.com/watch?v=AWjq0tlq1bs

PBS/Frontline produced a documentary about “The Interruptors”, available here.

In Memoriam: Mohamed Warsame Dualeh

May 3, 2026         Dr. Mohamed Warsame Dualeh, a Somali physician, refugee-health leader, humanitarian official, and later diplomat, died on April 25, 2026 in Germany.  He is survived by his wife, Marie Therese Lenz, and children, Amalie, Issa, and Edna.  Among the positions he held during his distinguished career were Head of Operations in Darfur for UNHCR and Director of the Somalia Refugee Health Unit.

Over a career that spanned public health, refugee operations, and international diplomacy, he served vulnerable communities across Somalia, the Horn of Africa, Sudan, and beyond.  He retired in 2014 and became adviser to the President’s office in Somaliland, working hard to get the new nation organized in public health and soliciting international recognition and support.  He continued to offer his services to the UN into 2025.

He was born on April 14, 1954.  He graduated from the Benadir Medical School in Mogadishu and the University of Sydney where he obtained a Master’s degree in Public Health, writing his thesis on maternal and community health worker care for diarrheal diseases of children in rural Somalia.   As Dr. Ahmed Magan remembers: “Dr. Warsame was my medical school classmate and graduated with distinction. He was a pioneer in Somalia, recognizing early on that public health and Primary Health Care (PHC) were the most effective ways to serve a community with limited resources and a high disease burden.”

His formative experience was with the Refugee Health Unit in Mogadishu, which coordinated care for Ethiopian refugees who had fled to Somalia.  That early work grounded the rest of his career:  he belonged to the generation of Somali doctors whose medical service quickly became inseparable from conflict, displacement, and the survival of uprooted families.  The RHU oversaw up to 35 camps of Ethiopian refugees.  Dr. Dualeh wrote: “It is extremely important to take health care to the refugees – to have an outreach program.”

Mike Toole recalls: “I worked with Mohamed Warsame Dualeh in Somalia in 1981 and 1982 when I was the senior medical adviser in the Refugee Health Unit (RHU) within the Somali Ministry of Health. The RHU coordinated the health programs within … camps for one million ethnic Somali refugees from Ethiopia scattered throughout the country…Mohamed eventually became the RHU director, based in Mogadishu. He was a major force in establishing the RHU as a unique national unit that based the Refugee Health program on epidemiological evidence, primary health care, community participation, standard treatment protocols, and prevention. …He was a trailblazer in Refugee Health …[in] a stellar career in the UNHCR.”

Beverly Snell explains about the RHU: “It was the first …primary health care (PHC), community-based approach to refugee camp health management…. Traditionally refugee health care had been very top down and often dependent on foreign professionals. …it was the leadership of people like Mohamed Warsame that made it work.  So much so that the host population was complaining that refugees had better health care than they did.  And that led to starting the PHC approach in the host population to, (a harbinger for the policy adopted by the Sphere Handbook).  Mohamed Warsame’s contribution in the leadership of both RHU and national PHC made a huge impact.”

Kate Burns remembers: “He was always Warsame to me.  Great guy.  Very easy to get along with…we met again when I joined UNHCR’s Health Unit in 1995/6 in Geneva…a really lovely man.  I loved greeting him in the few Somali words I remembered.  ‘Nabad, Suba Wanagsan, Nabad Geleyo’.”

With the RHU, Dr. Warsame oversaw an historically important model refugee health team, a model that merited being replicated around the world.  It was an all-star team of experts who created standards such as serial surveys of malnutrition among children in the camps to identify changes in the rates of malnutrition, knowledge of breastfeeding and oral rehydration, and other life-saving measures.

Surveillance in the camps in the early-80s revealed an outbreak of scurvy, a vitamin C deficiency disease, caused by a lack of camel’s milk in the refugees’ diet, an overdependence on standard rations provided by donors, and an accompanying lack of access to local markets where they might have bartered for fresh vegetables such as tomatoes and onions.

Dr. Jama Gulaid recalls:  “I will remember Mohamed for his devotion to the health and welfare of refugees. I travelled hundreds of miles with him while doing refugee work. Our challenges were many — heat, dust, and poor accommodation and food — but still immensely better than those facing refugees. Mohamed was undaunted, his energy undiminished, a spark in his eyes as he engaged vulnerable people as warmly as a physician in a comfortable office in a developed country.”

In a 1994 UNHCR paper about refugee family health, Dr. Warsame argued for a practical and humane principle that seems to capture his whole approach: “It is extremely important to take health care to the refugees – to have an outreach program. It has to be easily accessible.”  In the same piece, he recalled conditions in Hartisheik, of Somalis in Ethiopia, this is incomplete in 1988, where mortality among children under age five was exceptionally high in part due to inadequate food rations, and inadequate provision of water and sanitation compounded the crisis. He advocated for training refugees as health workers and birth attendants, and bringing care closer to families instead of forcing desperate mothers to travel long distances for help.

He served in multiple roles for the United Nations High Commissioner for Refugees (UNHCR), including as its focal point for HIV/AIDS and chair of IAAG, serving in the Programme and Technical Support Section in Geneva.

CDC’s Brent Burkholder remembers “I remember him as being a kind, quiet person but very committed to refugee health”

UNHCR Nutritionist Angela Berry Koch remembers: “He was always with a great sense of humor. Very warm and amiable. He had strong humanitarian instincts and argued against the limitations of institutions when they were less than humane. In that sense he showed a subtle kind of leadership   was astute politically, knowing when to push and when to fall back on diplomacy. Very smart guy.”

In the RHU and at UNHCR, he cared about refugee access to health care, distances to clinics, camp layout, and the daily burdens placed on women and children.

Angela Berry:  “Mohamed came with extensive field experience in primary health care… he was always willing to support our field colleagues, always cheerful and joking. He had a very warm personality. He was very tolerant of everyone from whatever background or culture. He was extremely generous and selfless, highly dedicated in all his endeavors.  He never hesitated in being placed in the worst type of conditions while expertly negotiating and spearheading the repatriation program… often found in isolated areas with landmine risks. He showed great courage and flexibility in his work. Always highly intelligent… loved field work. He always had a jovial spirit and a twinkle in his eye.”

Ron Waldman: “I first met Warsame when he was a young, recent medical graduate working for the Somali Refugee Health Unit in refugee camps in what is now Somaliland.  He rose rapidly up the ranks to become the Director of the RHU and went on from there to have a long career at UNHCR.  Throughout he was modest, spoke softly, but had a major impact.  He was a quick learner and what he learned early in his career was the importance of community-oriented primary health care.  Having seen the success of this approach during his RHU years, he continued to advocate for it on behalf of all of the vulnerable and marginalized populations he worked with in East Africa for the following decades.  He was always a pleasure to work with, a great listener who asked insightful questions and then questioned the answers he received.  And always with that quizzical smile and a twinkle in his eye.    He was an important figure in the development of the way we think about refugee and humanitarian health today.”

Rita Bhatia met him in Ethiopia and served a decade with him in Geneva at UNHCR:  “I admired Mohamed’s humility, simplicity & warmth and respect for people…[he] will be deeply missed, but never forgotten. Om shanti.”

In later years, he also moved into diplomacy and public advocacy. He served as Special Envoy of the Republic of Somaliland to the United Nations and other international organizations, while remaining a trustee of AHA.   Matt Bryden says he “will miss his great warmth, humor and intelligence.”

Looking back, Dr. Warsame said “Africa, as a whole, is a great continent welcoming refugees.”

He also said, “Sudan is in my heart. I dream of the great days and friends that I met in Kassala, Khartoum and Al Fasher.”

Dr. Magan reflects: “As a close friend for many decades, I remember Mohamed as a down-to-earth, exceptionally kind, and selfless person. He had a remarkable ability to connect with people and maintained a wide circle of friends globally. He was wonderful company, and whenever he was present, the room was always filled with laughter and jokes.”

He was a doctor shaped by the Horn of Africa, committed to refugees, and convinced that humanitarian work had to begin with dignity, proximity, and respect for the lives people were actually living. His career joined clinic and camp, epidemiology and diplomacy, Somalia and the wider refugee world. He appears to have been one of those indispensable officials whose name was not widely known outside professional circles, but whose work touched thousands of lives.