What the World Health Organization Executive Board resolution got wrong on humanitarian assistance

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You may have seen the January 2015 WHO Executive Board resolution on Ebola, which calls for many important things, including a global health reserve workforce, a contingency fund, and human resource management reform. All could help develop a smarter global health system.

But did you see this paragraph on humanitarian asssitance, which points decidedly in the wrong direction?

Emphasizing also the fundamentally civilian character of humanitarian assistance, and reaffirming, in situations in which military capacity and assets are used as a last resort to support the implementation of humanitarian assistance, the need for the use to be undertaken with the consent of affected States and in conformity with relevant provisions of international law,

Fortunately, this is in the preamble, and in the present context, has no impact. The countries affected by Ebola welcomed international support, including military capabilities; "consent of affected states" was not at issue. Yet this is a misleading statement as a matter of law that I believe ought not pass silently. It is a reminder of the struggle to ensure global priority of human rights over assertions of sovereignty, of the need of constant vigilance to ensure that old, destructive norms do not re-emerge.

In general, humanitarian assistance should be provided with the consent of affected states. In most cases, states do consent, soliciting and welcoming support. Yet sometimes, particularly when the state is not a victim of a humanitarian crisis – due to a natural disaster or disease outbreak – but the cause of it, the state blocks efforts to provide humanitarian assistance. Think Sudan and Darfur, or Syria.

When the state obstructs humanitarian assistance, it is violating people’s human rights, among them the right to the highest attainable standard of physical and mental health. States obligations include respecting this right, that is, not affirmatively undermining it. Yet when a state interferes with humanitarian assistance, that is precisely what it is doing.

In such cases, states violate their international legal obligations. As UN Secretary-General Kofi Annan famously stated more than a decade-and-a-half ago: “No government has the right to hide behind national sovereignty in order to violate the human rights or fundamental freedoms of its peoples.”

The international community has a responsibility to provide humanitarian support even in the face of resistance. At the 2005 UN World Summit, states agreed  “to take collective action, in a timely and decisive manner…should peaceful means be inadequate and national authorities manifestly fail to protect their populations from genocide, war crimes, ethnic cleansing and crimes against humanity.” Humanitarian assistance is a central component of protecting the population, so that those displaced or otherwise affected by the violence can survive. Otherwise, they too will become causalities of these crimes.

The World Summit, I believe, articulated an obligation that had already existed, most obviously in cases of genocide through the Genocide Convention, but beyond. It exists through articles 55-56 of the UN Charter, with their obligation for states to cooperate in advancing universal observance of human rights (which cannot happen if a state blocks humanitarian assistance) and the obligation of international cooperation and international assistance in the International Covenant on Economic, Social and Cultural Rights (article 2).

Sadly, state interests – or should I clarify, interests of governments concerned about their own power – may stop them from living up to this commitment. Still, at least once, just last year, the United Nations Security Council put the Responsibility to Protect into effect in the context of humanitarian assistance. In July 2014, the Security Council passed Resolution 2165 (with its message restated in a December resolution) on the Syrian war. It asserted humanitarian pathways into Syria, regardless of state consent:

  1. Decides that the United Nations humanitarian agencies and their implementing partners are authorized to use routes across conflict lines and the border crossings of Bab al-Salam, Bab al-Hawa, Al Yarubiyah and Al-Ramtha, in addition to those already in use, in order to ensure that humanitarian assistance, including medical and surgical supplies, reaches people in need throughout Syria through the most direct routes, with notification to the Syrian authorities….

The resolution required simply notifying the Syrian government, not its consent. And the Syrian government was obliged to comply. The resolution continued:

  1. Also decides that all Syrian parties to the conflict shall enable the immediate and unhindered delivery of humanitarian assistance directly to people throughout Syria, by the United Nations humanitarian agencies and their implementing partners, on the basis of United Nations assessments of need and devoid of any political prejudices and aims….

The Security Council has done tragically little to back up its decision following Syrian government interference. Yet as a matter of law, the July 2014 resolution stands as a clear counterpoint to the WHO Executive Board’s assertion of the necessity of consent of the affected states.

Where did the WHO Executive Board statement come from? The statement cited to two resolutions. One, a 2005 UN General Assembly resolution that addresses deploying military assets in support of humanitarian assistance, seems to contradiction the Executive Board’s assertion, if one views its silence on state consent as significant. The most relevant paragraph of UN General Assembly Resolution 60/124 reads:

  1. Emphasizes the fundamentally civilian character of humanitarian assistance, reaffirms the leading role of civilian organizations in implementing humanitarian assistance, particularly in areas affected by conflicts, and affirms the need, in situations where military capacity and assets are used to support the implementation of humanitarian assistance, for their use to be in conformity with international humanitarian law and humanitarian principles;

State consent is nowhere to be found here.

UN General Assembly Resolution 69/135, a 2014 resolution that the WHO Executive Board also cited, does include state consent, and reads much like the WHO Executive Board resolution:

Emphasizing also the fundamentally civilian character of humanitarian assistance, and reaffirming, in situations in which military capacity and assets are used as a last resort to support the implementation of humanitarian assistance, the need for their use to be undertaken with the consent of the affected State and in conformity with international law, including international humanitarian law, as well as humanitarian principles,

As a matter of law, a General Assembly resolution (much less part of its preamble) is not legally binding (true too of a WHO Executive Board or World Health Assembly resolution), unlike a Security Council resolution or, most significantly, the obligations created by the treaties and customary law that underlie humanitarian and human rights law.

Still, it is worth asking how did the issue of state consent creep into the 2014 General Assembly and the 2015 WHO Executive Board resolutions, even as this is at odds with human rights law and the responsibility to protect, and the Security Council resolution passed only months earlier? I suppose the answer rests with the same nefarious forces that continue to believe that their own power and the sanctity of state consent can override human rights and humanitarian principles and law. Too often, in practice, they are right. It is our challenge to support putting human rights principles into practice – and support those who so heroically risk their well-being and even lives to champion these rights – so that some day, human rights obligations and not power politics will rule the day.

Posted in Global Health, Human Rights, WHO; Tagged: , , , , , , , .


Trade leaks and litigation funds: how the tobacco industry reels us into more pointless battles

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Image courtesy of www.levinlaw.com

Image courtesy of www.levinlaw.com

A few weeks ago, I expressed my frustrations at the endless cycle of the tobacco industry demanding more and more evidence to justify simple tobacco control measures – and governments around the world giving in. Yesterday, parts of the Trans-Pacific Partnership’s (TPP), a trade agreement currently being negotiated between 12 countries including the US, were leaked. The leaks show that if the investment chapter of the TPP is enacted in its present form, it would provide another avenue for large corporations to sue governments when they try to pass laws protecting the public health (such as tobacco control). Read More

Posted in Global Health, Tobacco, Trade; Tagged: , , .


Understanding a Framework Convention on Global Health

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This post by Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, originally appeared on The Internationalist blog.

Lawrence GostinFor years, a group of global health scholars and practitioners have been pushing for the idea of a legally binding global health treaty—a framework convention on global health (FCGH). Grounded in the right to health, FCGH is anticipated to close the health gap between and within countries. The 2014 Ebola outbreak has highlighted the health disadvantages experienced by marginalized and poor populations in West Africa. Last week, Lawrence Gostin, University Professor and founding O’Neill Chair in Global Health Law at Georgetown University, and Lance Gable, associate dean for academic affairs and associate professor of law at Wayne State University, visited the Council on Foreign Relations to share their views on the prospects for FCGH and what it could accomplish in the realm of global health governance. Listen to this podcast for a “to-the-point” discussion of these issues and the important insights of Professors Gostin and Gable.

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So what exactly is in our legal pot?

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On Monday, a marijuana-testing lab in Colorado presented data on 600 samples of legal recreational marijuana. The results show cause for concern: three times the potency that marijuana had in the 80s, a decrease in CBD levels—the ingredient attributed to medical marijuana success—and the presence of contaminants such as butane and fungus.

Marijuana has been under-rese121913_cannabisarched, in great part due to the illegality of the drug. Most research has been stigmatized and the medical community has been heavily restricted in gaining access to research materials due to the Schedule I classification of the drug. The lack of scientific information we have on marijuana—and its effects or health consequences—is now becoming evident; the legalization of recreational marijuana in four US states (plus those that have legalized medical marijuana) has given way to the growing availability of a wide array of marijuana consumer products that are not properly regulated. Growing data, such as that presented on Monday at an American Chemical Society meeting shows that consumer protection is an area where legal marijuana regulation is still not up to par and where additional research and marijuana lab testing is strongly needed. Read More

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The O’Neill Institute Summer Program Is Back!

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It's that time of year! Join us for our 2015 O'Neill Institute Summer Program on Infectious Diseases.

Apply now at: www.oneillinstitute.org/summerprogram/2015

Posted in Global Health;


Injecting Compassion into the Vaccine Debate

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Photo courtesy of the LA Times

As a child I was surrounded by vaccine resisters. Nearly everyone I knew was vociferously opposed to the practice. We were particularly galled by the mandatory nature of vaccination—it seemed beyond the pale that such an invasive and traumatic procedure would be conducted without our consent.

There was one ringleader in particular who spurred on the rest—my sister. She believed firmly in leading by example. Her (not-so-passive) resistance to vaccination was legendary. She would run away, hide, scream, fight, and employ whatever other strategies she could devise in an attempt to avoid the needle. My dad, a pediatrician, was completely fed up. She made such a scene at his office that he began bringing the vaccine home to catch her off guard, leading to a betrayal of trust that took years to overcome.

My sister worked through her hatred of needles, eventually becoming a nurse, and all of us grew up to be regular injection-accepting (if not loving) adults. We ultimately recognized that our parents were not sadists, but understood, as a child can’t, that a small amount of pain is necessary to prevent far greater harm. In other words, we finally comprehended that vaccination was not a betrayal of trust but rather an act of love.

All that to say: None of us start out in the pro-vaccine camp; we are all converts. I am belatedly working my way through Eula Biss’s superb book, On Immunity. For anyone with an interest in the history, politics, and cultural implications of immunization, this is the best account of the subject I’ve seen. In particular, reading On Immunity has caused me to reflect on why some of us outgrow our innate fear of vaccines, while others don’t. Read More

Posted in Global Health; Tagged: , , , .


At the Intersection of Abortion, Advocacy & Pop Culture

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Image courtesy of Feministing.com

Image courtesy of Feministing.com

Even in countries where abortion has been legalized, women face numerous barriers when attempting to access the procedure. These include provider, facility, commodity, procedural, economic, information and stigma barriers. Stigma barriers are arguably the hardest to tackle, since they reflect deep-seated cultural values and judgments. Pop culture, however, can serve as a powerful tool for reducing the societal shaming of women who seek abortions and health care providers who perform them. Here are just a few examples:

Read More

Posted in Global Health, Human Rights; Tagged: , , , , , , .


Women and noncommunicable diseases in the United States

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Women runningInternational Women’s Day on March 8 caused me to reflect on the impact of non-communicable diseases (NCDs) on the lives of women in the United States.

Four principal NCDs – cardiovascular disease, cancer, diabetes, and chronic lung disease are largely caused by four shared and modifiable risk factors: tobacco use, harmful use of alcohol, poor diet, and physical inactivity. These modifiable risk factors pose serious and sometimes unique challenges for women and girls.

NCDs as a cause of death among females in the United States

According to the Centers for Disease Control and Prevention’s (CDC) latest statistics (2011), cardiovascular disease (heart disease and stroke) is the leading cause of death of females in the United States, resulting in 29% of all deaths. Nearly 22% of females die from cancer, 6 % from chronic lower respiratory diseases, and 2.8% from diabetes. Read More

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Scheduling Ketamine under the Convention on Psychotropic Substances of 1971: WHO Veto Power?

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Currently, the Commission on Narcotic Drugs is meeting in Vienna, Austria and one of the most debated issues is whether the Commission will vote to schedule the drug ketamine under the Convention of Psychotropic Substances of 1971. Regarding this issue, a critical legal interpretation question exists – does WHO have the power to veto the scheduling of a substance under the aforementioned Convention?


Bottom line: If WHO does not have veto power, and if the parties to the Convention decide to schedule ketamine, then a high risk exists that a drug on the Essential Medicines List may become much harder to access and acquire.

By way of background:

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Posted in Global Health, Uncategorized, WHO;


WHO: A Spoon Full of Sugar? Well…But Don’t Overdo It

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Prior to joining the O’Neill Institute, Disney’s Mary Poppins’ “A Spoon Full of Sugar” would never have triggered for me a single thought about obesity or diabetes. After all, the message is that keeping a positive attitude can make the most boring of tasks fun, or at the very least, bearable. However, the funny thing about working in the public health space is that one becomes sensitive to such things. More and more, child obesity is a growing concern around the world and marketing sugary drinks and snacks to children is one of the main contributors to this problem. Now, the more I learn about the effects of sugar in our bodies, “a spoon full of sugar” becomes much less appealing as a metaphor for looking at the bright side of life.

According to the World Health Organization (WHO), we should be limiting our sugar intake to 6 teaspoons per day, 12 at the most. On March 4, WHO issued new guidelines recommending that our daily sugar intake be reduced to less than 10% and that a further reduction to 5% (6 teaspoons) would lead to actual health benefits.

Read More

Posted in Global Health, WHO; Tagged: , , .

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