Portal de Periódicos da CAPES

Two urgent actions related to international health emergencies amid the escalating conflict in Gaza

2023; Wiley; Volume: 39; Issue: 2 Linguagem: Inglês

10.1002/hpm.3720

1099-1751

Tiago Correia,

Migration, Health and Trauma

Specific circumstances of the escalating conflict in the Gaza Strip makes the protection of civilians serious cause for concern. These circumstances include Israel's response to the hideous Hamas offencive, suggesting that a military retaliation of unforeseen consequences is on the way, especially since the recent escalation comes in the wake of long-running violence that goes beyond fighting forces.1, 2 Not surprisingly, geopolitics is already being felt on the ground with dozens of countries siding with one party. In addition, Gaza's geography contributes to the territory's huge vulnerability, with over 2 million people crammed into 365 square kilometres between Israel, Egypt, and the Mediterranean. In the face of the spread of communicable3 and non-communicable diseases,4 WHO has classified the Gaza Strip as a 'low-resource setting', thus needing ongoing international support to strengthen the infrastructure, workforce, surveillance, planning, policy, and management of its health systems.5 An evaluation of the readiness of the Palestinian health care system4 has shown significant gaps in the availability of essential medicines, basic services and equipment and diagnostic capacity, meaning that any disruptive event will lead to mass suffering. The point in this conflict is not so much who is right but rather the protection of those who have nothing to do with it and deserve respect under the international law, be they Israeli or Palestinian. Another point is that health protection leverages cooperation, solidarity, and mutual respect, and human suffering should actually bring people together. After all, pathogens extend far beyond man-made political, military, ethnic, and religious borders. These messages have been endorsed at international level. The May 2023 UN Security Council is a fine example, in which Secretary-General Guterres warned, 'The world is failing to live up to its commitments'.6 These messages absolutely must be applied to the current Israel-Hamas conflict. The signs are not encouraging though, as air and artillery strikes on Gaza intensify and Israel announces a total siege possibly preceding a major ground invasion. Previously, the documented destruction of hundreds of health facilities and death of health professionals in the conflict in Ukraine reveals the extent to which international laws have been comprehensively undermined. WHO has called for humanitarian corridors, given that hundreds of thousands of people are expected to be displaced in Gaza, compounded by shortages of water, food, medicines and sanitation. From a public health lens, the near future in the region is not hard to predict, as Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean said. It is therefore time to call for the implementation on the Gaza Strip of guidelines and best practices aimed at addressing health system shortages in settings of vulnerability and conflict. WHO has highlighted four areas that significantly minimise the negative impact of conflicts on the lives of civilians in these circumstances: supporting national implementation of International Health Regulations, stopping attacks on health care, making health facilities safe and providing access to essential health services.7 The last three are of particular importance in the Gaza Strip. Greater attention and mobilisation must be devoted to attacks on health care. As of October 12th, the sixth day of conflict, the Gaza Strip faced 75 of these attacks, which impacted transport (n = 56), healthcare workers (n = 56), patients (n = 37), facilities (n = 19) and supplies (n = 2). None of these attacks were reported in Israel so far. As these numbers are expected to rise in the coming weeks, close attention must be paid to WHO's Surveillance System for Attacks on Health Care (SSA),8 which publishes standardised data on world-scale attacks on health care. This is of key importance in reporting people deprived of urgently needed care. At stake are all fragile and emergency-affected territories. The way to prevent these attacks is to document them. Reliable, solid information used by international courts and agencies, public authorities and civil society are the best way to advocate for change. It is necessary to raise awareness that no attack on health care is legitimate or defensible. A safe health facility means the ability of facilities to remain intact, accessible and functioning at maximum capacity. For this to happen, it is critical to ensure quality materials, hazard-resistant construction, proper equipment, critical supply services (water, food, electricity and medical supplies), and a well-prepared workforce.9 In a context of armed conflicts with high potential for destruction, all of those involved in the dispute are morally obliged to allow neutral third parties to safely enter the field to repair damaged health facilities and/or instal temporary ones that ensure safety. Essential health services mean immediate access to basic forms of prevention, diagnosis and treatment of diseases, notably in maternal and child health, immunisation, nutrition, mental health, and sexually transmitted diseases. Patients, families and professionals need to be sent by safe land or air means of transport to more specialised services. Again, it is urgent to ensure the cooperation of those involved in conflicts in not hindering access to vulnerable areas. The high burden of diseases and deaths in these contexts is undeniable: 70% of cases of epidemic-prone diseases (e.g., cholera, measles and meningitis), 60% of preventable maternal deaths, 53% of deaths in children under 5% and 45% of infant deaths.10 In the Gaza Strip, WHO has already reported the need to refill or replace backup hospital generators and to boost provision of medical supplies. Also of great importance is achieving access to Israeli hostages to check on their health and wellbeing.11 Unfortunately, the recent escalation of the conflict in the Gaza Strip is just another episode, along with the conflict in Ukraine and long-standing fragilities in health systems in Yemen, Afghanistan, Somalia, the Democratic Republic of Congo, South Sudan and northern Ethiopia. So, it would be fair to say that suffering has been on the rise on a global scale. WHO estimates that the number of people in humanitarian need grew by almost a quarter in 2023 compared to 2022 in a total of 339 million people at high risk of outbreaks, preventable diseases and death, and lack of basic necessities.12 Climate change poses even more complex challenges to health emergencies as growing syndemics—pathogens intertwined with other communicable and non-communicable diseases, socio-political environments and biotic and abiotic environmental elements—are expected to displace more people, increase outbreaks and affect food and water supplies. WHO expected a need for additional funding of $2.5 billion to handle 54 health crises around the world in 2023.12 The signs are clear as to the shortage of health protection resources to meet these challenges. Indeed, if today it seems clear how far the UN Sustainable Development Goals are from being achieved by 2030, one of the reasons is that the vulnerable have not been adequately protected. But just providing more resources is not enough. International agencies need to be given more autonomy from national and regional political agendas. The Covid-19 pandemic highlighted this need and showed that countries have to increase mandatory funding to WHO so as not to compromise sustainable health protection intervention. The fact that WHO is mainly a soft policy body—as it does not hold national sovereignty in health matters—makes it a neutral third party in relation to partial interests. It is only with this trusted status in mind that it is possible for international agencies to play the pivotal role necessary to make effective changes on the ground. A closer relationship with international judicial authorities (e.g. the International Criminal Court and International Court of Justice) would strengthen the mandate of these agencies without colliding with national sovereignty. The great current challenge in dealing with health emergencies lies precisely in finding mechanisms such as those that reinforce the protection of people who are not involved in conflicts within autonomous and sovereign countries. Current international geopolitics makes this progress both urgent and indispensable. Tiago Correia is PhD hab, Associate Professor of International Health at NOVA-Institute of Hygiene and Tropical Medicine (Portugal), and Editor-in-Chief of International Journal of Health Planning and Management. ORCID: https://orcid.org/0000-0001-8036-8814. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.