The World Health Organization (WHO) has always included in its mandate the imperative to connect health and peace, as stated in the preamble to its Constitution. This commitment has been demonstrated through previous international interventions it has championed, such as the ‘Health as a Bridge for Peace’ concept in the 1990s and 2000s. Building upon this historical foundation, the Global Health and Peace Initiative (GHPI) was launched in 2019 with the support of Switzerland and Oman. The initiative aims to reinforce WHO’s mandate in this critical area.
The GHPI aims to integrate the health sector into peace-building efforts, strengthening social cohesion and emphasizing an understanding of peace and conflict dynamics. It advocates for the incorporation of conflict sensitivity and peace responsiveness into relevant health interventions, all while aligning with WHO’s triple billion targets.
This emphasizes the need to comprehend the context in which the WHO and its partners operate in delivering health services, particularly in areas marked by social tension and conflict. The objective of the GHPI is to prevent unintentionally exacerbating such tensions while ensuring the effective and equitable delivery of health services.
In certain instances, involving community members in health delivery processes can help in identifying needs, fostering trust, promoting collaboration, and bridging healthcare disparities that may have contributed to tensions. Moreover, in contexts where conditions, capabilities, and risks permit, healthcare workers equipped with basic conflict resolution and mediation skills can play a role in fostering reconciliation, for example, through the utilization of Mental Health and Psychosocial Support services.
The plan leverages the advantage of health programs in bringing people together to foster trust and resilience within communities, as well as between communities and governments. Significantly, it was launched prior to the eruption of several contentious conflicts, such as those in Ukraine, Sudan, and Palestine, which have led to significant casualties, displacements, and attacks on health infrastructure and personnel.
Developing the Global Health and Peace Initiative
The GHPI is being crafted through multilateral consultations led by Oman and Switzerland. During the 152nd session of WHO’s Executive Board (EB) in 2023, WHO members highlighted the importance of considering national context and ownership, prompting calls for further consultations. Some members, including the Russian Federation, Syrian Arab Republic, and Egypt, raised concerns about potential infringements on states’ sovereignty, expressing doubts about the implementation of global, regional, or national social monitoring mechanisms through GHPI. They emphasized the initiative’s global scope should not intrude into governments’ interactions with their citizens or dictate states’ objectives and priorities. Denmark, speaking on behalf of the European Union and its member states, emphasized the necessity of clearly delineating tasks between WHO and its partners based on their respective mandates.
During the 76th World Health Assembly (WHA) later that year, states were presented with the 5th draft roadmap of the initiative, but this was not endorsed. While progress was acknowledged, concerns were raised by member states like Brazil regarding the potential politicization and securitization of health, as well as overlap with the mandates of other UN agencies such as the UN Security Council, UN General Assembly, Human Rights Council, and International Court of Justice.
Brazil emphasized the importance of clear language in the roadmap to prevent future derailment. Russia expressed willingness to engage with the GHPI but noted that the roadmap was still incomplete. Switzerland voiced support for consensus-building through further consultations. Following WHA76, the WHO Director-General was tasked with presenting a report on strengthening the roadmap of the initiative at WHA77 through EB154. Intersessional meetings with stakeholders included the presentation of a background paper featuring practical examples. Additionally, a commitment was made to provide an “internal WHO training handbook for programming purposes within WHO’s mandate” in 2024.
The discussion at EB154
During EB154, discussions were generally more amicable, with calls for further consultations and support for resource mobilization. While states like Maldives underscored the importance of capacity building on ethical issues to foster trust in the initiative, Brazil, China, and others reiterated the principle of state sovereignty and again cautioned against the politicization and securitization of health, as well as external influences on WHO.
Cameroon, which helped to pilot GHPI, representing 47 African countries, called for increased awareness and adoption of the initiative by other states, along with equitable resource mobilization and financing. On the other hand, France highlighted that the current document failed to fully recognize climate change as a driver of conflicts, particularly through its impact on food insecurity and forced migration. Ultimately, a draft decision outlining timelines was adopted.
Approximately 80% of the WHO’s efforts in emergencies occur within conflict-affected, vulnerable, and fragile settings. Regrettably, such settings are proliferating globally, leading to an increase in health and humanitarian crises necessitating global interventions. It’s important to recognize that the space for health interventions is diminishing due to violations of international humanitarian laws, such as attacks on health systems, healthcare workers, and civilians, for example in Gaza.
However, as described earlier, member states expressed concerns about potential violations of states’ sovereignty and the politicization of health through the GHPI, which could exacerbate challenges in conflict-affected settings. Recognizing the WHO’s unique position as one of the few international bodies trusted for its neutrality in conflict situations, the WHO Secretariat reassured countries that the primary objective of the initiative was to prevent further attacks on healthcare infrastructure during armed conflicts.
Blind spots of discussions on the initiative
Considering the GHPI and WHO’s involvement in emergencies such as those in the occupied Palestinian territories, questions arise regarding the initiative’s ability to promote peace through health in such complex settings. It becomes evident that expecting the WHO alone to champion peace amid ongoing armed conflicts is unrealistic. For instance, during the latest Executive Board meeting, Israel once again criticized the international community for allegedly showing preferential treatment to Palestine and declared its intent to continue attacks. If endorsed, the GHPI must clearly outline the scope of its actions to address such accusations and reaffirm the importance of ensuring delivery of health services even at times of armed conflict.
The initiative also appears to overlook gender-based violence and violence against children in conflict, fragile, and vulnerable (CFV) settings. The implementation of the initiative may further burden healthcare workers, highlighting the necessity for a GHPI task force specifically tailored to address challenges in such settings.
While the initiative primarily targets CFV settings, systematic training for health workers in all environments is crucial, as health programs must adhere to a ‘do no harm principle.’ Additionally, comprehensive data gathering on various attacks on health workers and health delivery services is essential for evaluating the initiative’s success and limitations.
Finally, the initiative lacks clarity on sanctions in the event of violations, such as human rights violations, highlighting the need for further definition in this regard. The consultative approach taken in developing the initiative is commendable, emphasizing the importance of inclusivity, transparency, and timely engagement. However, it is crucial to clearly articulate the added value of the initiative through evidence generation while also acknowledging its limitations. Transparency regarding both strengths and weaknesses is essential for effective implementation and ongoing updates.
Chiamo Seraphine is a health activist and mental health advocate based in Cameroon, and an alumna of the People’s Health Movement WHO Watch program.
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