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Multidisciplinary review linking three areas of legitimate enquiry for practitioners of medicine and public health. The first is occurrences of mass violence or genocide perpetrated against vulnerable populations, with a focus on the failure of national and international mechanisms to prevent and predict such violence. The second is evolving concepts of national sovereignty and an emerging framework in which the imperative to assist vulnerable populations supersedes the state's right to self-determination. The last is how medical, public health, and other systems of surveillance and rapid assessment of mass violence can accelerate public awareness and faciltate structured, consistent political decision making to prevent mass violence and to provide humanitarian assistance