June 9, 2021 | The Washington Post

Global health policy shouldn’t be shaped by a country that bombs hospitals

June 9, 2021 | The Washington Post

Global health policy shouldn’t be shaped by a country that bombs hospitals

Bashar al-Assad recently celebrated two election victories. In Syria, he claimed 95.1 percent of the vote in his run for a fourth term as president. The government reported that more than 14 million ballots were cast — even though that number exceeds the best estimates of the population (including children) living in areas under Assad’s control.

In an uncontested vote, the Syrian government also won a seat on the Executive Board of the World Health Organization, which reported last fall that it had documented 494 attacks on health-care facilities in Syria, mainly in areas under assault by Assad’s forces.

Assad’s reelection as president was a foregone conclusion. The response abroad was a mix of resignation and ritual criticism. Yet among Syrians living beyond Assad’s grasp, the elevation of his regime by the WHO elicited puzzlement and outrage. How could a U.N. agency, whose constitution identifies health as “one of the fundamental rights of every human being,” welcome into the ranks of its leadership a regime that has shown no remorse for bombing hospitals?

It would be a mistake to treat this as a rhetorical question. The pandemic has shown that a credible and effective WHO is integral to U.S. national security. Unraveling the agency’s problematic relationship with Syria can point the way toward reforms that help the WHO investigate pivotal questions, such as how covid-19 first infected humans.

President Donald Trump attempted to withdraw the United States from the WHO, an effort that President Biden canceled because the prospects of reform are far better “if we are there at the table,” not outside the organization. Syria’s ascent to the Executive Board shows that the White House needs to redouble its efforts.

At the annual gathering of WHO member states, which ended on May 31, representatives approved a slate of 12 candidates for the Executive Board without debate and without objection. The WHO chooses the board’s members from six global regions, relying on a mechanism that regularly approves a set of consensus candidates put forward by the governments within each region. Without up-or-down votes on each aspirant, a candidate such as Syria can sidestep opposition.

The outcome of this latest election highlights the need for reform. (Another country that won election to the board was Belarus, whose regime recently triggered a storm of international outrage when it illegally diverted an international flight so it could arrest a dissident journalist aboard.) Open ballots are essential so no state can vote for pariahs without taking responsibility for its action. The main reason that China, Russia, Venezuela and other violators win seats on the Human Rights Council is that the General Assembly casts secret ballots.

A seat on the executive board provides Syria with a vote on two pivotal matters. The first is the nomination of the director general. The second is the appointment of the WHO’s six regional directors. Tedros Adhanom Ghebreyesus, the incumbent director general, plans to seek reelection next year to another five-year term. Last year, a barrage of insults and false accusations from Trump generated sympathy for Tedros. Yet within weeks of Biden’s inauguration, the White House announced its “deep concerns” about the process and substance of the WHO investigation into the pandemic’s origins, warning Tedros that the agency’s reports must be “free from intervention or alteration by the Chinese government.”

Tedros is also grappling with the fallout from a major investigation by the Associated Press, exposing sexual exploitation of local employees in the Democratic Republic of the Congo by senior WHO officials, as well as a subsequent coverup by the WHO. Close ties to Tedros reportedly protected those officials from the consequences of their actions.

For Syria, the choice of regional directors for the eastern Mediterranean is key to insulating the Assad regime from accountability for its diversion of humanitarian assistance delivered by the WHO. At the height of the war, Assad’s forces regularly stripped medical aid from U.N. convoys headed for areas under rebel control, a violation of international humanitarian law. “Sterilization equipment [was] withheld, forcing surgeons to reuse surgical items without sterilization between operations,” wrote the physician and public health advocate Annie Sparrow. The WHO even spent millions subsidizing Ministry of Defense blood transfusion programs, despite Syrian forces’ record of atrocities.

Along with other U.N. agencies, the WHO effectively resigned itself to such arrangements. An internal U.N. assessment concluded, “the criticism of these abuses has seemed muted, presumably in a judgment about access over advocacy.” The prospects for reform depend on the appointment of a strong regional director who has the unequivocal backing of the director general. Now, with a seat on the Executive Board, Syria can defend the status quo.

“Re-engaging the WHO also means holding it to the highest standards,” the White House asserted in February. The re-engagement has taken place. The commitment to accountability remains uncertain.

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