By Beth Stinchcombe and Catarina Soares
With thanks to Harpreet Kaur, Lucy Singh, Brian Wong, Layth Hanbali and Rhiannon Osborne
Welcome to part 2 of our blog about the World Health Assembly (WHA). If you missed part 1, do check it out first as we go through what the WHA is and how it works, as well as what happened in the run up to and during the meeting. Here we’ll be talking about what we think went well and what could have been better, doing our part as a student organisation to hold those in power to account. We’re focussing on the last two pillars of our organisation, advocate and act: read on to find out how you can speak up and take action.
In part 1 we described how some international geopolitical conflicts impacted on proceedings and played out in the WHA. SfGH is a non-partisan organisation, but cannot be apolitical – because health and healthcare are shaped by political decisions.
The problem surrounding Taiwan’s non-admittance to the WHO has featured prominently, partly due to their role in the early stages of the outbreak, partly as a political weapon with which to attack China. Taiwan has seen a lot of support from Pacific island nations, which benefited from Taiwan’s solidarity with shipments of personal protective equipment. Taiwan has a democratic political system which should be defended and upheld, and their exclusion from global health governance hurts us all. The question we don’t have answers to is how to achieve this – China’s vast political and economic influence and permanent position on the UN security council make it difficult to fight on this issue. WHO membership is dependent on either approval by the WHA or recognition as a member of the UN: neither of which Taiwan has, and which rely on other Member States siding with Taiwan and against China on the dispute.
Sanctions on some Member States were also raised as a significant barrier to delivering healthcare, particularly during the pandemic. Relations between the US and Iran, Syria and Cuba are terse and the latter three have been deeply affected by economic sanctions levied on them by the former. Again, this is a complex issue: there are serious and credible allegations of crimes perpetrated by these authoritarian governments against their own populations, particularly in Iran and Syria but also in Cuba.
However, the question of who these sanctions truly affect needs to be asked. Although lessons were learned from the outcomes of indiscriminate sanctions on Iraq from 1990 to 2003, so-called “smart” sanctions applied to Syria were found by the UN Special Rapporteur Idriss Jazairy to be affecting access to medicines and humanitarian aid by the population. US sanctions on Iran have resulted in soaring inflation, affecting the population’s ability to buy basic goods. Amnesty International’s 2009 report into the effects of the US embargo on Cuba demonstrated that it restricts Cuba’s ability to purchase goods for its healthcare system and has socio-economic impacts on the social determinants of health.
US sanctions are the most stringent worldwide, and have far-reaching impacts by affecting non-US companies – some are extra-territorial, meaning the US can fine non-US companies for not complying if they have any business with the US. There are varying levels of restriction, from the most severe – all transactions are prohibited without authorisation by the US government – which affect Syria, Iran, Cuba, Sudan, North Korea and the Crimea region of Ukraine; to targeted restrictions, such as on the weapons trade or other specific items or services, which affect a longer list of countries to different extents. Fearing the repercussions from the US, many businesses avoid dealings with affected countries altogether, so as to ensure no problems.
It’s important to note that Iran, Syria and Cuba are not alone in curtailing their populations’ rights and freedoms: many countries across the globe do, and most of them are on the receiving end of US sanctions, particularly if we’re thinking about the strictest end of the spectrum. We need only to look at the $8 billion arms deal the US celebrated with Saudi Arabia, the United Arab Emirates (UAE) and Jordan last year: it’s difficult to look past the vast human rights violations by Saudi Arabia, who prosecutes human rights defenders, was implicated in the extrajudicial killing of reported Jamal Kashoggi, utilises the death penalty rampantly and enforces severe systematic discrimination against women and minorities, such as Shi’a Muslims and migrants; and by the UAE, who engage in arbitrary detention and torture, refuse nationality to thousands born in their territory (making them stateless), abuse migrant workers through a no-minimum-wage policy and tying their immigration status to their employers, and uphold discriminatory laws against women. Furthermore, all three countries are part of a coalition involved in the conflict in Yemen, where all parties have been accused of serious human rights violations and war crimes.So the question we ask is: why are the human rights violations in Syria, Iran and Cuba severe enough to warrant sweeping sanctions, but those perpetrated by Saudi Arabia, the UAE and Jordan can be ignored in favour of a major weapons deal? Answering the question as to why Iran, Syria and Cuba and not SaudiArabia is not easy – US relations with each of these countries is steeped in complex history, but it is hard to deny that there is an ideological and an economic component to these conflicts. The US itself doesn’t have a stellar human rights record, which also can’t be ignored.
Sanctions can be a useful political tool to promote human rights in certain conditions, such as by curtailing government-led attacks on the population through arms embargoes – this is why there are calls for the UK government to halt sales of riot gear that may be used for internal repression and police brutality during the Black Lives Matter protests. However, using them to “punch up” and make a statement to a powerful country that their actions are not acceptable is very different to using them to “punch down” and obliterate a weaker and/or poorer country’s ability to sustain an economy or a health system. In those circumstances, sanctions can be a way for powerful governments to bully smaller countries into submission by deepening humanitarian crises and controlling their economy. For these reasons, it’s important to call countries out when use of this tool ultimately harms those it purports to protect.
The Russian occupation of Ukrainian territory and Russian state sponsoring of the separatist movement in the East of the country is another difficult topic to address in the international forum. The conflict in Eastern Ukraine has driven healthcare professionals away and the population in the Non-Government Controlled Area have seen their healthcare systems disrupted or lost. The International Committee of the Red Cross (ICRC) has reported that fighting has intensified in the past weeks and access to water, sanitation and hygiene (WASH) facilities, so important during this pandemic, can be easily compromised. The right of the population affected by the armed conflict in Eastern Ukraine to access healthcare must be preserved – COVID-19 has just exacerbated the weaknesses in healthcare provision in the region and will further the deterioration of living conditions for the people affected.
Access to a new vaccine or treatment
Challenges to equitable access to personal protective equipment (PPE) were compounded by market failures in China and the bidding wars that ensued global shortages. This is highly problematic, as it results in high-income countries having access to the goods we all need and hoarding them, and leaving low- and middle-income countries empty-handed and unable to safeguard their health workers. High-income countries have a responsibility to engage in ethical procurement, as the dire consequences of bidding wars result in increased risk for health professionals in under-resourced settings. We understand that this is more easily said than done, and that governments have an ultimate responsibility towards their own healthcare workers, which they don’t want to leave at increased risk. This is a difficult problem which can only be addressed with global solutions – all countries need to agree to tackle this together.
The universal accessibility and affordability of any new treatments or vaccines has been a major topic surrounding this year’s WHA. Costa Rica has cooperated with the WHO to form and lead a voluntary patent pool for all COVID-19-related technologies. Others in the global health field, feeling this is not enough, have called for mandatory worldwide sharing of all COVID-19-related data, establishing a global and equitable rapid manufacturing and distribution plan fully-funded by wealthy countries, and guaranteeing all investigations, treatments and vaccines are free of charge and universal.
Intellectual property regulations must not be used to exclude people from access the medicines they need based on their ability to pay, and high-income countries mustn’t coerce lower- and middle-income countries not to utilise international law to protect the right to health of their population – re-affirming the TRIPS flexibilities in the resolution passed this WHA is an important element to pushing back on pressure by high-income countries on lower- and middle-income countries to forgo them.
We stand for any novel treatments or vaccines to be accessible to all and we support Universities Allied for Essential Medicines (UAEM) in their campaign to ensure publicly-funded diagnostic tools, treatment and the COVID-19 vaccine will be sustainably priced, available to all and free at the point-of-delivery and encourage you to learn more and spread the message about their public investment tracking tool. You can also make your voice heard by joining our campaign with Global Justice Now, UAEM, STOPAIDS and Just Treatment to email Matt Hancock’s office (the Secretary of State for Health and Social Care) supporting access for all to COVID-19 testing, treatments and vaccines.
Accessibility and equity
The biggest challenge an online WHA posed to civil society organisations (CSOs), such as the IFMSA, was the loss of one of our biggest tools: in-person advocacy. CSOs would normally have the opportunity to deliver spoken statements but this year the vast majority were limited to written statements submitted in advance. As we mentioned in part 1, a few NSAs delivered oral statements, but this was a very limited number and civil society’s ability to speak out was severely curtailed.
Furthermore, a big part of the role CSOs play at the WHA is finding key stakeholders in breaks or at side events and approaching them then – an element that was impossible to bring into the virtual forum. This is important both for advocacy but also for holding governments and international organisations to account in real-time. The question about whether online events will begin to play a bigger role in society at large, both due to COVID-19 and as we shift to more eco-friendly ways of living, raises the possibility that CSOs may need to adapt and find new ways to engage with decision-makers.
As SfGH and IFMSA, we have a lot to say about many of the issues raised at this WHA: you can find our policies linked throughout this blog. We’re dismayed by the loss of the chance to advocate at the 73rd WHA for health equity worldwide but we’ll continue pushing governments and other stakeholders to do what is right and for our right to be heard.
How can you get involved?
There are a few ways for students to get involved with the WHA. You can watch back the WHA as it has all been recorded on the WHO website (you can find the videos here) – you can watch it all or just clips. There is great commentary by other organisations online, such as the People’s Health Movement WHO Watch, Health Policy Watch, G2H2 and the Geneva Health File, and you can also check out the WHO’s advocacy brief “Gender and COVID-19”.
You can also participate by attending the 74th World Health Assembly next year or the European Regional Committee meeting held later this year: keep your eyes out for the announcement on IFMSA’s social media – as an SfGH member, you’re eligible to apply!
The side events have moved to the virtual world, and have been opened to everyone so do check them out, as many have recordings freely available online that may interest you. You can find “Never have I ever…From Youth advocates to Global Health Leaders: Youth Forum and Careers in Global Health”, hosted by IFMSA and available on their Facebook page here.
If any of the topics we’ve briefly covered interest you, don’t hesitate to reach out to us to get involved in our campaigning, starting a campaign of your own or developing educational resources for SfGH members (like a blog post or helping to write a short course, for example). IFMSA released a toolkit helping you to navigate heavily political topics as a member of a non-partisan organisation.
Lastly, IFMSA and members have been tweeting about the WHA using the hashtags #IFMSAWHA73 and #Youth4Health – if you have something to say and want to get involved in the discussion, join in!