Why Was Syria Just Elected to the WHO’s Executive Board?

A regime that bombs hospitals and blocks convoys of baby formula does not deserve a leading role in global health.

Guest Contributor: Zaher Sahloul, a critical care specialist in Chicago and the president of MedGlobal. This piece was originally published in the Foreign Policy on July 6, 2021.

Throughout the course of the Syrian civil war, the Syrian regime of President Bashar al-Assad has displaced half the country’s population. It has depopulated whole cities and villages by bombing hospitals and schools, thereby undermining the principle of medical neutrality and impartiality — which mandates noninterference with medical services in times of armed conflict and civil unrest. The regime has moreover starved its people by blocking convoys of humanitarian aid — including those carrying baby formula — from reaching besieged civilians. It has also used prohibited chemical weapons more than 300 times, with children frequently among the victims, and allowed infections like polio and leishmaniasis that were effectively eradicated in Syria to resurface by blocking vaccines and medications from reaching regions that fell under the control of the opposition. The life expectancy of a Syrian child has been reduced by 13 years.

In return, the Assad regime has been rewarded by being elected to a leading role in the World Health Organization (WHO). In May, Syria won a seat on the WHO Executive Board — atop the same organization that reported last year that it had documented 494 attacks on health care facilities in Syria from 2016 to 2019, mainly in areas under assault by Assad’s forces.

This is not a joke. The regime that has caused one of the largest human displacements since World War II is now a part of a group that sets and enforces the standards and norms for the global governance of health care. It is an absurd episode for an organization that is in much need of self-reflection and reform — both from the WHO Director-General Tedros Adhanom Ghebreyesus, who is seeking an election for a second term, and from United Nations Secretary-General António Guterres.

The WHO Executive Board is made up of 34 representatives appointed by member states. They hold three-year terms, setting the organization’s agenda and implementing its policies. The election might be just another symbolic and bureaucratic procedure that slipped through the cracks of a rigid institution disconnected from the field, but it has prompted outcry from Syrian health care workers and nongovernmental organizations that have suffered the regime’s wrath.

The Syrian regime is responsible for what is called the weaponization of health care — the strategy of using people’s need for health care as a weapon by violently depriving them of it. Weaponization is multidimensional and includes practices such as attacking health care facilities, targeting health care workers, obliterating medical neutrality, and besieging medicine. It amounts to what human rights organizations call a “war-crime strategy.”

The Assad regime has employed aid as an instrument of war throughout the Syrian conflict.

The Assad government has employed aid as an instrument of war throughout the decadelong Syrian conflict, repeatedly denying assistance to civilians it perceives as hostile or disloyal and diverting it to advance military aims. The big irony at the core of this strategy is that Assad — who was just elected for his fourth term with 95.1 percent of the vote in another sham election — is himself a medical doctor who was trained in Syria and the United Kingdom. (In fact, we were classmates at the College of Medicine at Damascus University for six years in the 1980s. At the time, no one expected him to become the person he became after he inherited the presidency following his father Hafez al-Assad’s death in 2000. Indeed, Bashar’s Hippocratic oath did not prevent him from unleashing his war machine on fellow doctors.)

After the five-year siege of the Damascus suburbs of eastern Ghouta ended in 2018, the WHO and the International Committee of the Red Cross determined that the Syrian government stripped aid convoys of 70 percent of their medical supplies, including trauma kits, surgical kits, insulin, and other vital materials. It has also repeatedly attacked aid convoys, including those to which it granted permission to deploy to opposition-controlled areas.

During my humanitarian medical work in Syria between 2012 and 2021, I worked in hospitals in Aleppo and Idlib that were bombed multiple times by the same Syrian regime that now sits at the table that sets global and regional norms and standards for equitable health care based on international humanitarian laws.

South of Idlib in 2016, I met with Hassan al-Araj, a cardiologist at the Central Cave Hospital of Syria, a hospital that he built inside a cave in the village of Kafr Zita so as to protect it from Syrian and Russian bombs. But later that year, a heat-seeking missile killed him while he was leaving the premises. He joined some 930 doctors and nurses killed by the Syrian and Russian war machines between 2011 and this March. Fifty-five percent of them died of aerial attacks or shelling.

According to the WHO, as of December 2020, only 50 percent of public hospitals across Syria were fully functioning. Twenty-six percent were partially functioning due to a shortage of staff, equipment, medicines, or damage to hospital buildings, while the remaining 24 percent were not functioning at all.

In September 2016, the U.N. Independent International Commission of Inquiry reported, the Syrian Air Force “meticulously planned and ruthlessly carried out” an attack on a joint U.N. and Syrian Arab Red Crescent humanitarian convoy, killing 14 aid workers, halting relief operations, and destroying $650,000 worth of supplies destined for opposition-held areas in Aleppo. The attacks haven’t stopped. According to the U.S. State Department, the Assad regime is continuing to hamper the delivery of aid from humanitarian organizations to millions of Syrians who face a growing crisis of poverty, economic collapse, and joblessness in all regions. Nine out of 10 Syrians now live below poverty line. Meanwhile, in areas of the country held by the Syrian government, the regime is obstructing access to aid groups by imposing visa restrictions and other administrative obstacles.

Given this record, many are wondering how the WHO — a U.N. agency whose constitution identifies health care as “one of the fundamental rights of every human being” — could welcome into the ranks of its leadership a regime that has shown no remorse for bombing hospitals and targeting health care workers.

The WHO chooses its executive board members from six global regions. It relies on a weird and secretive system that approves a set of consensus candidates that governments within each region put forward via secret ballot. There is no formal process of voting or debate. This undemocratic setup has allowed countries like Syria and Belarus to sidestep potential opposition to their membership.

Syria’s inclusion within the WHO’s top body could undermine trust with the international system.

Syria’s election couldn’t have come at a worse time for the WHO. The organization is under a lot of pressure after its poor performance during the COVID-19 pandemic, and there is a perception among Western governments and human rights groups that the organization caved to pressure from China and other authoritarian regimes to toe their own lines and heed their narratives. Indeed, former U.S. President Donald Trump attempted to withdraw the United States from the WHO, an effort amended by President Joe Biden to pushing for reform within the organization. Now, Syria’s inclusion within the WHO’s top body could further undermine trust with the international system at a time when confidence in multilateral organizations is much needed.

The decision is also bad for the Syrian people and will further fuel COVID-19 vaccine hesitancy in a country where it is already high. Syrians have a historic distrust of the Assad regime and its health policies. Syria has finally received AstraZeneca vaccines through the WHO’s COVAX initiative, in addition to Russian and Chinese vaccines donated to regime-controlled areas. But why would Syrians trust the vaccine guidelines of an organization that elected to its board a regime that undermined their health?

Syria’s crumbling health system was already at a breaking point before the pandemic. Now, the government’s mishandling of the COVID-19 outbreak is further endangering health workers and the general population. There are already reports of vaccine inequities: The regime is known to reward its loyalists by providing them with better health care than civilians who happen to live in such restive areas as Daraa, Ghouta, and northwest Syria.

Throughout the course of the pandemic, the Syrian authorities have denied health care workers personal protective equipment and other supplies donated by the WHO. They also appear to be significantly underreporting COVID-19 case counts. As of July 2, the country has reported only 25,551 cases of COVID-19 and 1,879 deaths — not per day, but total. Medical experts have called these numbers into doubt. Imperial College London’s COVID-19 Response Team estimated in September 2020 that only 1.25 percent of actual coronavirus deaths in Damascus were being counted.

But that’s not all. To add insult to injury, Russia — the main ally of the Syrian regime — has been threatening to cut the only lifeline to the 4.2 million Syrian civilians trapped in Idlib. Idlib, a landlocked governorate in northwestern Syria that borders Turkey, is the last region under the control of the opposition. Half of its population is internally displaced; having fled the Assad regime from other regions that fell under its control, 1.2 million people today live in tent camps along the Syrian-Turkish border.

According to the U.N., around 1,000 trucks full of humanitarian aid supplies travel through the militarized Bab al-Hawa border crossing from Turkey to northwest Syria each month. About three-quarters of the approximately 4 million people in northwestern Syria depend on the U.N. to meet their basic needs, and the U.N. says this cross-border operation reaches nearly 85 percent of those people monthly. But now, Moscow has suggested it may veto a U.N. Security Council Resolution that allows it. Doing so would leave more than 1 million Syrians hungry and deprive hospitals of much needed medical supplies and vaccines in the midst of an ongoing pandemic.

In a recent U.N. Security Council meeting, the current U.N. special envoy for Syria, Geir Pedersen, stated once again that “the Syrian tragedy will go down as one of the darkest chapters in recent history,” and that Syrians have “faced human rights violations on an enormous and systematic scale.”

So, for many Syrians and human rights advocates all over the world, the right signal to the Syrian regime is an overdue referral to the International Criminal Court, not an election to an organization that sets the standards for global health.

aher Sahloul is an associate professor at the University of Illinois at Chicago and the president of MedGlobal, a medical nongovernmental organization that supports health care in disaster regions. Twitter: @sahloul

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