As discussed earlier, poverty and associated disease rarely arise de novo. Heavy burdens of disease predictably strike those places, most often resource-poor communities, where structural violence weighs most heavily. Moreover, structural violence (institutionalized biases and inequalities including racism, elitism, gender inequality, militarism, and economic policy that fosters inequity) often emanates from global centers of power and privilege, and increases the risk of encounter with communicable disease. 18 Rwanda's recent history makes these processes clear. The 1994 Rwandan genocide took an enormous toll on the population: at least 800,000 Rwandans massacred in 3 brutal months by approximately 15% of the population. 19 However, what commonly escapes our memories is that the Rwandan genocide was predicated on far more than physical violence alone. Structural violence played a significant role in setting the stage. Uvin 20 has argued that an uncritical development enterprise, dominated by foreigners, contributed to the creation of the processes that led toward genocide. In Aiding Violence, he summarizes: