From the closest bus stop, the shift in focus is immediately apparent. A walk along the Avenue de la Paix (Peace) takes one past sculptor Daniel Berset’s monumental broken chair statue, conceived to encourage a multi-national ban on anti-personnel mines and cluster munitions. In the background, stands the European headquarters of the United Nations in the beautiful Palais des Nations (originally built in 1929 to house the League of Nations). A bit farther on, a statue of Gandhi greets passers-by, adorned one recent day with tributes to the late Russian political activist and prisoner, Alexei Navalny.  

The Red Cross/Red Crescent museum itself sits at the foot of the International Committee of the Red Cross (ICRC) headquarters, a large white building atop a hill. A modern glass and steel structure houses the collection where visitors are invited to learn more about the organization’s origins, as well as the long-standing alliance between individual Red Cross and Red Crescent national societies that provide humanitarian relief around the world. 

While the organization of exhibits in the museum’s permanent collection is not strictly chronological, a sculptor’s dramatic all-white rendering of Henri Dunant seated at a desk—and accompanying text—explains the Geneva resident’s role in the founding in 1863 of what is now the International Red Cross. Dunant, who was first inspired to create a relief effort to alleviate the suffering of soldiers after witnessing the 1859 battle of Solferino, Italy, also participated in the framing of the original Geneva Convention of 1864. On display in a nearby case, copies of that document contain language that reflects the authors’ optimism, “Ambulances and military hospitals shall be recognized as neutral…Wounded or sick combatants, to whatever nation they may belong, shall be collected and cared for.” Subsequent versions that expanded on the protections outlined—thereafter referred to as the Geneva Conventions—were drafted respectively in 1906, 1929, and 1949, with the lattermost document still remaining in effect.  

To safeguard both those providing care and wounded soldiers, the Convention “established a universally protective symbol: a red cross on a white background.” (There has been some debate about whether the white cross on the emblem was intended to carry religious significance or was simply chosen as a readily recognizable symbol, i.e., the inverse of the Swiss flag.) A little more than a decade later, use of the red crescent—a symbol more readily recognizable to Muslim soldiers—was initiated, with formal adoption of this symbol in 1929. Today, the red crystal emblem is used by allied societies in regions where the population does not identify with the cross or the crescent.  

Throughout the museum, the response of the Red Cross and the Red Crescent to humanitarian crises around the world is documented through a variety of materials including photographs, artifacts, and facsimiles of official records. The experiences of survivors in more recent conflicts and natural disasters are brought to life through additional media, including music, graphic representation, and recorded testimony. A striking example is found in the Hall of Witnesses where visitors can sit face-to-face with greater-than-life-size videos of survivors describing their experiences—among them, a former child soldier, a civilian who lost his legs but now works with other amputees, and a woman who experienced multiple displacements from her home country. 

The youngest victims of conflict come into focus in a haunting display of photographs posted along the wall of a nearby room; the accompanying text explains that the children portrayed are survivors of the 1994 Rwanda Genocide. Separated from their relatives at such an early age many did not know their family identities, or even their own names, making reunification difficult and sometimes impossible.  

Fortunately, there is hope to be found as well. In the Restoring Family Links section of the museum, more testimony may be viewed and heard, describing instances in which families separated by conflict have been reunited by the Red Cross and Red Crescent. Stories of recovery and resilience, even among individuals who might have given in to despair, amaze and inspire. 

In another gallery, a display of artwork crafted by prisoners and made primarily from found materials serves as testament to the desire for creative expression among those who have yet to attain their freedom. Among these works: a locomotive made by a French prisoner in Germany in 1941; a set of playing cards drawn by a Moroccan prisoner held by the Polisario Front (a group seeking independence in the Western Sahara) in 1998; and a miniature palace put together by Lebanese prisoners in Israel in 1999. (A book of this artwork is available in the museum shop.) 

With not all threats to human dignity stemming from civil wars, nationalist movements, repressive governments and militia, the Red Cross and Red Crescent also work to prepare vulnerable populations for natural disasters. A small area of the museum is devoted to this work, while a newer threat, cybersecurity is addressed at the Data Detox bar, where a pick-and-choose your own cocktail metaphor is used to provide “…steps you can take to control your digital privacy, security, and wellbeing”; cards that summarize this information are available to take home. 

Leaving the exhibits behind, in the lobby of the museum, the departing visitor is reminded of the power of literature and art to communicate our moral obligation to alleviate human suffering, as well as our capacity to do so. A quote from Dostoevsky that runs along one wall recalls our universal responsibility to one another, while nearby, observers are invited to add their own bit of weaving to artist Zahrasadit Hakim’s tapestry-in-progress, an example of how the cumulative efforts of many changes, supports and enhances the whole. 

The Museum of the International Red Cross and Red Crescent
https://redcrossmuseum.ch/
Av. de la Paix 17, 1202 Genève, Switzerland.  

Photo of the Red Cross/Red Crescent museum from wikicommons

In Dangerous Medicine: the Story behind Human Experiments with Hepatitis, Sidney A. Halpern tells the story of America’s decades-long investment in hepatitis inoculation experiments, of which the infamous Willowbrook study was only the final and perhaps most egregious example. The experiments began in 1943 in response to an epidemic of “serum” hepatitis among military draftees who had received yellow fever vaccine. The initial idea was to characterize the infectious agent that caused the disease and to examine its clinical features under controlled conditions. In later years, studies involved testing various preventive measures, both for serum (B) and infectious (A) hepatitis.  

During World War II, the Armed Forces Epidemiology Board (AFEB) initiated a series of inoculation studies among conscientious objectors, prisoners, and mental patients. Most of the subjects were conscientious objectors who volunteered, despite having a wide variety of service options. “Virtually all the men serving as hepatitis subjects spoke of a desire to engage in meaningful and consequential humanitarian service.” (p. 63) Investigators told the volunteers, “It is our judgment that the possibility of permanent or even protracted or severe impairment of liver function following participation in the jaundice experiment is very slight.” (p. 48) At that time, of course, long-term consequences of hepatitis B infection—chronic infection, cirrhosis, and hepatocellular carcinoma—were unknown. However, many of the subjects did develop clinical disease and at least one subject developed fulminant liver failure and died.  

After the war, hepatitis researchers relied almost exclusively on institutionalized subjects. For example, Joseph Stokes Jr. of the AFEB “not only drew subjects from a mental hospital and multiple institutions for children, but he also enlisted inmates from five state correctional facilities… in New Jersey.” (p. 101) Stokes claimed the research was “beneficial for both the facility and its residents.” (p. 96) Later, researchers at Johns Hopkins, Yale, and the NIH conducted studies at other institutions. For prisoners, participation offered multiple benefits, including the possibility of early release. Among the objectives of studies during the 1950s were attempts to eradicate the infectious agent by sterilizing the infected serum, which were unsuccessful. During these studies, four subjects died of fulminant hepatitis, two at McNeil Island Penitentiary in Washington and two at Lewisburg Penitentiary in Pennsylvania.  

Willowbrook was one of two long-term hepatitis inoculation programs begun in 1956. At the time, Willowbrook State Hospital on Staten Island had one of the largest populations of the cognitively impaired in the USA. It was the overcrowded home to some of the state’s most disabled patients – 39% were non-ambulatory, and 64% unable to feed themselves. A New York University team, later headed by Saul Krugman, professor of pediatrics, established a hepatitis unit which each year admitted approximately forty-eight children between three and ten years of age. Many of the experiments involved injecting subjects with serum containing live infectious (A) or serum (B) hepatitis virus. Major study findings included clearly distinguishing between the natural history and characteristics of hepatitis A and B, and discovering that gamma globulin was an effective means of preventing clinical illness in hepatitis A. 

This decades-long sequence of inoculation studies occurred despite post-war developments in research ethics. The Nuremberg Code was promulgated in 1947, followed in 1964 by the Helsinki Declaration. These documents established principles designed to protect the rights and welfare of research subjects, including respect for individuals, voluntary participation, informed consent, risk/benefit analysis, confidentiality, and scientific integrity. However, at least in the United States, hepatitis investigators, among others (e.g. Tuskegee syphilis study), ignored or evaded these principles.

Except for wartime experiments on conscientious objectors, hepatitis inoculation studies violated almost every ethical principle set forth in the Nuremberg Code and Helsinki Declaration. The vast majority were conducted in closed institutions among subjects who either lacked the ability to consent, or whose participation was not necessarily voluntary (i.e. prisoners). Where consent was obtained (e.g., from a prisoner or surrogate), the investigators provided incomplete or false information (e.g. stating that risk was minimal), despite several deaths from fulminant liver failure. Yet, Joseph Stokes claimed that virus inoculation could “in our opinion be of benefit to the individual himself.” (p. 98) In addition, coercive tactics were used (e.g., quicker admission to an institution, or earlier release from prison).  

Dangerous Medicine highlights unethical practices in American hepatitis research throughout the mid-20^th century. While contemporary ethical standards had yet to be established, broad ethical principles articulated by the Nuremberg Code and Helsinki Declaration and reiterated (at least, in part) by the American Medical Association, were ignored. Public outcry in 1972 against Willowbrook, Tuskegee and other unethical research led in 1974 to the establishment of the National Commission for Protection of Human Subjects of Biomedical and Behavioral Research and, subsequently, to the Belmont Report, the Common Rule, Institutional Review Boards, and contemporary standards in human subjects research. Interestingly, as far as Dr. Halperin is aware, no follow-up studies have ever been done to ascertain the long-term health consequences of these hepatitis study subjects.  

Dangerous Medicine tells a sobering story, well-worth reading. And, given the prevalence of academic incentives and multiple conflicts of interest, I’m afraid the story of unethical research is far from over 

1. Beecher HK. The Ethics of Clinical Research. New England Journal of Medicine. 1966; 274: 1354-1360. 

Dangerous Medicine: The Story behind Human Experiments with Hepatitis
Sydney A. Halpern
Yale University Press, 2021
304 pages 

Web image of Hepatitis B from Wiki Commons