Improving Global Health Governance in Armed Conflicts: Lessons from COVID-19

Beier Nelson, Lucy Tu, and Fatima Cody Stanford

As the world emerges from the COVID-19 pandemic, the global community is confronted with a different type of outbreak—not of disease, but armed conflict. According to the United Nations (UN), we are currently witnessing the highest number of violent conflicts since World War II. Global health governance systems must have compliance from the international community to support the well-being of populations caught in the crossfire. Such measures foster public health and build a foundation for preventing new hostilities.

Armed conflicts wreak havoc on all facets of health. At the most direct level, war takes a toll through loss of life, injuries, and the enduring scars of generational trauma. The reignited Israeli-Palestinian War, for instance, has claimed over 18,000 lives, with a majority being civilians.

Furthermore, combatants often violate international humanitarian law by targeting medical personnel and healthcare infrastructure. In Gaza, over 125 health workers have been killed, 200 health workers arrested, and 123 healthcare facilities damaged. This targeting of the healthcare system is not an isolated feature of the crisis in Gaza; for example, the ongoing Russo-Ukrainian War has witnessed over 700 documented attacks on hospitals.

Lastly, armed conflicts destroy public health systems, creating a breeding ground for the rampant spread of infectious diseases. In Gaza, the collapse of the water infrastructure and the Israeli blockade on food, water, and medical supplies have raised concerns about famine and imminent outbreaks of cholera and jaundice. These intertwining impacts on health and infrastructure emphasize the urgent need for humanitarian intervention to address both immediate health crises and the long-term consequences of compromised healthcare systems in conflict-ridden regions.

International governance structures, notably the UN, are pivotal in managing conflicts between nations and fostering global peace. At the forefront of global health initiatives is the World Health Organization (WHO), which oversees 193 member states, coordinating the response and implementation of guidelines to address health threats worldwide.

Recognizing war as a health emergency underscores the imperative for international collaboration. Lessons gleaned from the cracks exposed during the COVID-19 pandemic highlight the need to refine the dynamics between WHO and its member states. Applying these insights ensures a more robust and responsive approach to health crises in times of armed conflict.

First, the COVID-19 pandemic revealed the importance of transparent data sharing between WHO and member states. In the initial stages of the pandemic, WHO was not able to secure reliable data from China and did not declare a global emergency until January 2020. By then, the virus had already spread beyond China into other nations; since WHO heavily relies on health data provided by its member states to formulate timely public health guidelines, a lack of data transparency by member states severely reduces its capability to respond to health emergencies.

These transparency challenges are part of a broader non-compliance issue, hampering WHO efforts as the organization needs more enforcement tools and political power to enforce its principles. In 2021, WHO member states, on average, implemented only 70% of the International Health Regulations (IHR), WHO’s framework for managing disease outbreaks and other significant public health challenges. Glaring manifestations of this issue arose during the COVID-19 pandemic, ranging from WHO’s inability to convince Turkmenistan of admitting to COVID-19 infections in the counry to its failure to curb the surge of vaccine nationalism during the pandemic resulting in stark inequities in vaccination rates between countries. In 2021, over half of the world’s COVID-19 vaccine supply was acquired to serve the wealthiest 13% of the global population.

Non-compliance with WHO guidelines threatens to destabilize relationships between the organization and member states. In June 2020, the Trump administration suspended financial support and initiated a process to withdraw the United States from WHO, but President Biden reversed these actions upon taking office in January 2021.

The importance of a strong WHO-member state relationship extends beyond pandemic contexts. In times of war, WHO relies on data from member states to assess available humanitarian aid supplies, facilitating distribution to needy areas. Presently, WHO oversees the coordination of humanitarian supplies for Gaza, where 1.6 million civilians urgently require food, water, and medical provisions. Maintaining open communication with WHO is crucial to ensure that affected populations receive the necessary humanitarian support.

Securing buy-in from member states is paramount. In December 2023, WHO called for a resolution of uninterrupted humanitarian aid in Gaza, and there have been more recent resolutions by the UN Security Council to protect the flow of aid. It is the international community’s responsibility to heed the calls for humanitarian assistance. There is an urgent need for ongoing cooperation between WHO and its member states to effectively address the health repercussions of war and foster a climate of peace. Such collaboration is necessary to achieve the ideals of global health and human rights.

Beier Nelson, Department of Government, Harvard College, Cambridge, United States.

Lucy Tu, Department of Sociology, Department of the History of Science, Harvard College, Cambridge, United States.

Fatima Cody Stanford, MD, MPH, MPA, MBA, Massachusetts General Hospital, Boston, United States. Email: fstanford@mgh.harvard.edu