PHM-Exch> [PHM NEWS] WHO's Global Health for Peace Initiative welcomed WHO EB

Claudio Schuftan cschuftan at phmovement.org
Mon Jan 30 19:55:51 PST 2023 

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From: People's Health Movement <dlegge at phmovement.org>



Trust, inclusion, and resilience are key assets for community health
everywhere

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WHO's Global Health for Peace Initiative welcomed

WHO’s Global Health for Peace Initiative was launched in November 2019 and
the White Paper
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1bd3d04619&e=125964ddcc>
was published in 2020. The White Paper provides detail regarding background
and logic of the initiative and sketches the framework of what has become
the draft road map.

In Jan 2022 the EB reviewed EB150/20
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=abb3cd003a&e=125964ddcc>
in which the Secretariat:

   - reviewed the rationale and mandate for WHO to engage in such an
   initiative;
   - presented an overview of the Initiative, highlighting the ideas of
   ‘mainstreaming’ ‘conflict sensitivity’ and ‘peace responsiveness’ into
   WHO’s programmes (contributing to the ‘peace dividend’);
   - identified six workstreams, including evidence generation; advocacy
   and awareness-raising; capacity-building; and partnership development.

The EB adopted EB150(5)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1470610ebe&e=125964ddcc>
which recommended that WHA75 ask the Secretariat to consult widely and
develop a detailed roadmap for the implementation of the Initiative for
consideration by WHA76. WHA75 (May 2022) adopted decision WHA75(24)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4f02b8340c&e=125964ddcc>
as recommended.

At EB152 (which started this week in Geneva) WHO's Executive Board will
review EB152/17
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=5fd1cb4a9e&e=125964ddcc>
which reports on the results of consultations on the way forward and
presents a revised draft road map
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=12fc6832d4&e=125964ddcc>
for the Global Health for Peace Initiative.

The Board is invited to provide further guidance regarding the draft road
map with a view to submitting a further revision to the Seventy-sixth World
Health Assembly in May 2023.
Development of Health for Peace Initiative

A detailed presentation of the H4P initiative is set out in the White
Paper, Health and peace initiative
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=60cb648659&e=125964ddcc>,
2020.

See also:

   - UNGA (2015)  Report of the High-level Independent Panel on Peace
   Operations on uniting our strengths for peace: politics, partnership and
   people
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3d56c4cc01&e=125964ddcc>
   (A/70/95, from page 9);
   - UN Women Peace and security page
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1916116f2f&e=125964ddcc>
   ;
   - Discussion of health and peace at WHA34
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=97aaaeba3b&e=125964ddcc>
   (1981)
   - WHO (1996) Consultation on Health as a Bridge for Peace
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e9bfb76d75&e=125964ddcc>
   (WHO/HPD/96.7)
   - Garber (2002) Health as a Bridge for Peace
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2c35f9a389&e=125964ddcc>:
   Theory, Practice and Prognosis — Reflections of a Practitioner, J of
   Peacebuilding and Development, 1(1), 69-84
   - Wiist, W. H., Barker, K., Arya, N., et al (2014)
   <https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=dde437c612&e=125964ddcc>.
   The role of public health in the prevention of war: Rationale and
   competencies. American Journal of Public Health, 104(6), e34-47.

See Tracker links
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=8d8cb061de&e=125964ddcc>
to previous reports, discussions and decisions by WHO governing bodies
regarding health and peace.
Excellent initiative

The WHO’s Global Health for Peace Initiative’s focus on mainstreaming
conflict sensitivity and peace responsiveness into the strategies and
programs of WHO and its many collaborators is very welcome.

As an intergovernmental forum WHO has limited policy space when its member
states are directly involved in conflict (including covert operations).
However, as part of the UN system WHO is expected to contribute as part of
a multi-sectoral approach to conflict response and peace-making. This can
be challenging when UN involvement, including UN authorized sanctions,
intensify the harm caused by the conflict.

The Health and Peace Initiative has modest aims and it offers interesting
possibilities for advancing both peace and healthcare in conflict zones.
One of the main approaches it moots – its first theory of change- is moving
from working in conflicts to working on conflicts through what it calls
conflict-sensitivity and peace-responsive programming, and to do this while
working across UN agencies and across WHO. Its second level theory of
change talks of improving citizen-state cohesion, cross-line collaboration
and the promotion of health and well-being and dialogue.

The revised draft road map
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=515b5fea0c&e=125964ddcc>
still needs greater clarity on its deliverables, strategies and priorities.
Accordingly PHM welcomes the proposal for the development of a more
detailed roadmap for consideration at WHA76.
Issues needing further attention

In PHM’s comment on this item at WHA75
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52da60a01b&e=125964ddcc>
we expressed our support and highlighted a number of areas where the
documentation could be strengthened. These suggestions remain relevant to
the redrafted road map.

*Evidence generation through research and analysis* is a critical part of
the road map. Documenting, reporting and investigating the impact of war,
armed conflicts and communal riots on health should be the evidence that
drives change. The documentation and evidence so generated must be
presented in an annual report.

The road map envisages the mainstreaming of its conflict sensitive and
peace responsive approach and highlights social cohesion, trust,
resilience, and inclusion as key variables in applying this approach. These
variables and their drivers should also figure on the research agenda of
the initiative. Action research to document how peace responsive
programming can impact on social cohesion, trust, resilience and
discrimination (includng ethnic and gender discrimination) would be
extremely valuable.

*Violence against women and girls.* The draft road map recognises the need
for special attention to be directed to the plight of women, young girls
and children who are often the worst sufferers of the conflict; being
subject to physical and sexual violence, being denied basic amenities
including food, and often being trafficked with impunity. Ethnic and racial
discrimination, migration and displacement, while problems in their own
right, add to the problems of women, young children and all marginalized
populations. The roadmap must build on Security Council Resolution 1325
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=36fd61073a&e=125964ddcc>
and the Convention on the Elimination of  All Forms of Discrimination
Against Women (CEDAW), including CEDAW General Recommendation 30
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c38028587f&e=125964ddcc>.
No post-conflict or  peacebuilding effort can be successful until countries
ensure that measures are taken, and systems are put in place, for victims
of rape and other gender-based violence to testify and seek justice for the
crimes perpetrated against them.

*Attacks on health workers and civil society organizations working in
health.* As part of its evidence-based approach the Global Health for Peace
Initiative makes recording and reporting on the alarming number of attacks
on health workers and their resources, including ambulances, a priority.
These attacks need to be mainstreamed into conflict analysis and given
priority as they undermine fundamental rights, international humanitarian
law, and deny potential peace dividends.  Such attacks deny access to
healthcare, especially for populations made vulnerable by insecurity. All
actions that deny or unnecessarily delay access to healthcare need to be
recorded and reported on.

Many of these are due to check-points and excessive bureaucracy, but all of
these negatively affect the social cohesion that is a key aim of the Global
Health for Peace Initiative. If health workers are prevented from carrying
out their work through arbitrary detention or a denial of their rights this
is also an attack on, and denial of, healthcare.  If the link between
health, social cohesion and peace is to be operationalized in situations of
protracted conflict and insecurity, it is essential that any acts that
threaten social cohesion and access to healthcare be called out.

In this context PHM draws attention to the attacks on health workers and
healthcare facilities by Israeli forces in occupied Palestine including the
incarceration of Ms Shatha Odeh, a member of PHM’s Steering Council and
Director of the Union of Health Work Committees
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=00f19c5ac4&e=125964ddcc>,
a leading healthcare organisation working in the occupied territories. The
annual reports provided to the WHA about the health circumstances in
Occupied Palestine (access here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=af4f2e2758&e=125964ddcc>)
illustrate the limits on WHO's reach when global superpowers are involved.

*Conflict analysis.* The H4PI emphasizes conflict analysis and the need to
understand the specific nature of individual conflicts in order to promote
peace. This is welcome. Conflict analysis needs to shed light on the
multiple roots and drivers of aggression. These could lie in vertical or
horizontal inequalities, the power dynamics of oppression, the remnants of
a colonial past, or a neo-colonial present, as well as the more commonly
cited ethnic divides and resource accumulation motives. Being able to
demonstrate the present-day consequences - for health - of these drivers
puts WHO in a unique position to draw in collaborative partners to address
them.

The revised road map needs to prioritise the analysis of contemporary
conflict situations, for example in Myanmar, Palestine, Ethiopia, Eritrea,
South Sudan, Somalia or Nicaragua. The paper by Garber 2002
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b3e7ea3b95&e=125964ddcc>
demonstrates the usefulness of a case study approach to strategy
development and capacity building.

*Economic sanctions.* Global Health for Peace Initiative documents do not
mention economic sanctions, the use of which has increased dramatically in
recent decades. The damaging consequences of blanket economic sanctions for
health are well known. Some sanctions have been authorised by the UN;
others have been imposed unilaterally, enabled as a consequence of the
domination of international finance by one currency. WHO has a key role to
play in recording and reporting the health consequences of these sanctions
and bringing them to the attention of sanction-using countries through the
appropriate UN mechanisms, and to the relevant UN bodies if the sanctions
are UN-approved.

*Partnerships.* PHM appreciates the emphasis in the draft road map on
partnerships, in particular the importance of partnerships with civil
society organizations as recognised in the second level theory of change
outlined in the White Paper (p20).  Civil society organisations should be
involved in all of the six workstreams. Their engagement in partnership
development and capacity building will be critical.

*Capacity building* will be critical including at the regional and country
levels. The competencies suggested by Wiists and colleagues (2014)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=93b72a15f5&e=125964ddcc>
provides a useful resource.

*Mainstreaming conflict sensitivity.* Country level health interventions
should be attempted in all conflict related displacements. But the
operational team providing or facilitating healthcare needs to be supported
by an expert H4PI team, mandated to undertake the analysis, engage in
health diplomacy, and facilitate societal and community level interactions.

*Negotiating political sensitivities.* WHO is already subject to great
power bullying when it strays into the domain of geopolitics (as with the
attacks on WHO in the early months of the Covid pandemic) or in dealing
with the impact of trade agreements on health. Careful thought will be
needed to protect the H4PI from intimidation and coercion. One option would
be to provide for the systematic involvement of a representative group of
member states and civil society organisations in overseeing and guiding the
implementation of the Initiative (and providing the Secretariat with some
defense against great power bullying).
The wider relevance of the H4P approach

PHM appreciates the comment in para 35 of the (second) draft roadmap: "*The
‘health for peace’ approach focuses on fragile, conflict-affected and
vulnerable settings but is also relevant in any setting where social
cohesion, resilience and trust need to be built, sustained, or strengthened*
".

Trust, inclusion, and resilience are key assets for community health
everywhere. A lack of trust and of solidarity has been evident in the Covid
response in many countries.   There are forces in many societies which seek
to gain advantage by disparaging ‘the other’.

The ‘approach’ of the GH4P Initiative as described in paras 28 and 29 of
the draft roadmap could be realised in health care delivery in most if not
all societies: delivering health services in ways which also contribute to
inclusion, trust building, and social cohesion.  Such an approach would
correspond closely to the model of health care delivery envisaged in the
Alma-Ata Declaration on Primary Health Care.

*PHM welcomes the Health for Peace Initiative and supports the continuing
development of the implementation road map.*
------------------------------

See our more detailed commentary on this item here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7bf26465db&e=125964ddcc>.
The Tracker page for EB152 is here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0a35db4f4d&e=125964ddcc>
.

The WHO Tracker
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=777034a538&e=125964ddcc>
and PHM item commentaries are produced as part of WHO Watch which is a
project of the People's Health Movement
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=58f3d140cb&e=125964ddcc>
in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2e5d542884&e=125964ddcc>,
Third World Network
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f344741806&e=125964ddcc>
and a number of other civil society networks. WHO Watch aims to contribute
to democratising global health governance, through new alliances, new
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You can support WHO Watch by publicising the Tracker; by inviting others to
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