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Equality for all must be upheld as a guiding principle for all our societies
by Adeeba Kamarulzaman, Allan Maleche, Chris Beyrer
The Lancet Medical Journal
Still relevant: the 75th anniversary of the Universal Declaration of Human Rights, by Adeeba Kamarulzaman, Allan Maleche, Chris Beyrer for The Lancet Medical Journal
December 10, 2023, marks the 75th anniversary of the founding commitment of the modern human rights movement, the Universal Declaration of Human Rights (UDHR).
75 years on, the world is tested and tormented by an agonising array of conflicts in which human rights violations are not secondary outcomes, but rather central to such conflicts. Ethnic cleansing, collective punishment, apartheid, sexual violence as a tool of state terror, and the deliberate targeting of health-care facilities and workers are part of multiple ongoing conflicts in 2023.
The unprovoked Russian invasion of Ukraine in 2022, civil conflicts underway in Tigray in Ethiopia, Sudan, Myanmar, and Syria, the conflict between Israel and Hamas in Gaza, and the Saudi-led coalition's bombardment of Yemen, all have in common violations of the rules of conduct in war—specifically, attacks on civilians, health-care workers, health-care facilities, and infrastructure and other violations of medical neutrality.
These attacks are also violations of the right to health; through the denial of health-care access, they undermine the principle of dignity and the equal value of all human lives.
Armed conflict is an extreme domain of human rights abuses, but is only one of many settings in which human rights violations are taking place. Other concerns that undermine the right to health include the deliberate degradation of our environments and the climate for short-term profit and the widespread use of disinformation and misinformation that adversely affects people's rights to benefit from scientific progress. Disinformation related to the safety and efficacy of vaccines has led to multiple disease outbreaks and to losses of life during the COVID-19 pandemic.
Political and legal attacks on the rights of sexual and gender minorities, and on the rights of women, undermine the universality of human rights and are occurring in countries as diverse as Iran, Russia, Uganda, and the USA.
Indeed, in his opening address to the 53rd Council of the UN Human Rights Council in June, 2023, Volker Turk, the UN High Commissioner for Human Rights, reaffirmed the centrality of the UDHR for our deeply troubled times precisely because of its core principle of universality.
The global community backs away from the universality of human rights at its collective peril. In 1948, the UDHR was crafted in the wake of the Nazi persecutions of Jewish people, Roma, LGBT persons, individuals with disabilities, and others deemed unfit to live by the Nazi regime.
The relevance of the UDHR was also clear in the decades that followed World War 2, notably in the struggle against the avowedly racist apartheid regime in South Africa, which was also a struggle to realise universal rights. Equality for all must be upheld as a guiding principle for all our societies. The responsibility to protect rights cannot be left to our current political systems and human rights bodies, including the UN, because they are manifestly failing to do so in many places.
How relevant, then, is the human rights framework to health in these troubled times? How can the global health community press for universal health coverage, committed to by heads of states at the 79th Session of the UN General Assembly in September, 2023, when we see so many millions of people denied the most basic health services, including the substantial numbers of internally displaced people and refugees?
And what are the possible roles and potential actions health-care workers can undertake to address these threats?
First, the tools of population-based sciences need to be used more intensively and routinely to document and measure human rights abuses; this information can be used to hold governments and other actors to account. These tools, exemplified by the use of novel satellite technologies and video surveillance in the documentation of Russian atrocities in Bakhmut and other cities in Ukraine, hold great promise for accountability for war crimes.
Second, health-care workers must put human rights at the forefront of our work and become much more engaged in efforts to protect the rights of those we seek to serve. This is a pressing reality for many obstetric care providers in US states, for example, where multiple restrictions on reproductive and sexual health and rights have adversely affected the practice of medicine, endangered patients’ lives, and put health-care providers in legal jeopardy for providing essential care.
Third, medicine and health care must be a more active participant in advocacy for health-care access as a human right in all societies. No one should be denied health-care access by virtue of legal or immigration status—yet multiple health systems do just this, and providers must not be complicit in these denials of access to care.
Fourth, common cause is needed with those advocating for inter-related rights, including the movement for addressing the climate crisis and for climate justice, anti-racist struggles, the LGBTQ+ rights movement, and the global movement for women's rights to bodily autonomy, choice, and freedom from sexual and gender-based violence, among others. Health-care workers have agency in these struggles and need to influence these social and political debates. Health-care workers cannot stay in our professional domains and expect others to address these crises.
To address the rising tide of human rights violations and their many and varied impacts on health, the International AIDS Society and The Lancet convened a multidisciplinary Commission on health and human rights in 2019.
The Commission's report is expected to be released in early 2024. This report will aim to explore multiple domains of health and rights and will argue for a reinvigoration of the UDHR as a basis for protecting health in the 21st century.
Human rights protections are not optional, and they are not reserved for the fortunate few who are citizens of countries that now enjoy peace and prosperity. If we consider the climate crisis alone, our collective rights to enjoy a liveable and healthy environment are under existential threat.
Young people worldwide know that their survival is at stake, and many have been organising and winning court cases based on their right to a liveable future.
For those living under repressive regimes and trying to survive in the world's expanding zones of conflict and displacement, human rights have proven stubbornly cherished hopes for a better future. Health professionals must do everything we can to ensure that future and uphold human rights in protection of humanity's common survival.
* Adeeba Kamarulzaman and Chris Beyrer are the Co-Chairs and Allan Maleche is a Commissioner of the International AIDS Society-Lancet Commission on health and human rights; this Commission has been supported by the International AIDS Society and by the Desmond M Tutu Professorship at the Johns Hopkins Bloomberg School of Public Health.
* Marking The Lancet Medical Journal's 200th anniversary, this special issue features critical issues impacting health globally: http://www.thelancet.com/lancet-200
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Children should not be paying the price of our inaction with their lives and their futures
by Ted Chaiban
UNICEF Deputy Executive Director
“In the entirety of my more than 25-year career with UNICEF, it is hard to recall a year in which the situation facing children affected by conflict and disaster has been as dire as the one we are currently witnessing.
For humanitarian organizations, our work has rarely been as important, and may never have been more complex. The horrendous situation in Gaza, which shakes us to the core of our humanity, exemplifies this. Earlier this week, UNICEF launched a US$9.3 billion emergency funding appeal to reach at least 93.7 million children in 155 countries.
“Yet at a time when humanitarian and protection needs have never been greater, we are approaching 2024 facing an increasingly bleak funding forecast. Flexible funding – which allows us to respond at a speed, scale and nimbleness only possible with this kind of funding – is shrinking, restricting our ability to respond quickly and ensure principled action based on needs. And humanitarian actors’ ability to safely reach affected populations where they are is increasingly at risk, as we continue to see attacks against humanitarian aid workers around the world.
“Throughout the year, children around the world have faced rampant violations and denials of their rights. In November, I spent a week in Ukraine, where I visited frontline areas in the Kharkiv and Zaporizhzhia regions, and stressed the urgent need for continued humanitarian response in conflict-affected areas.
In October, I went into Gaza where we have now seen unprecedented numbers of children reportedly killed in the continuing violence. In July, I met families in Sudan, where millions of children have been forced from their homes in what is now the largest child displacement crisis in the world.
“Beyond the headline-grabbing areas affected by conflict and other crises, there are other children suffering as well. This year I met children in need in Jordan, Lebanon, Egypt, Chad and Mali. Such devastating conflicts, combined with a rise in climate-related disasters, disease outbreaks and displacement, mean children continue to endure the unimaginable impact of protracted crises and emerging threats.
“In all of these contexts, UNICEF is on the ground, providing children and families with essential life-saving aid, and exploring innovative new solutions to challenges that have plagued humanity for centuries. But at a time when humanitarian and protection needs have never been greater, we are concerned that our ability to meet the needs of children is going to come under significant strain.
Critically underfunded emergencies include Sudan, Burkina Faso, Democratic Republic of the Congo, Myanmar, Haiti, Ethiopia, Yemen, Somalia, South Sudan and Bangladesh. UNICEF and our partners are committed to providing a comprehensive response to the many humanitarian crises affecting children, but children should not be paying the price of our inaction with their lives and their futures. They need continued access to essential services, like health care, safe water, basic sanitation and education.
“When I was in Sudan, I met with Mahmoud a 12-year-old in a temporary learning centre outside of Attbara who was continuing to study through an e-learning programme set up by UNICEF but what he really wanted to do was return to his home in Khartoum. He showed me a drawing of his neighborhood which he did, complete with the bombed-out pharmacy across the street from his house and the parking lot where he and his friends played football, and he just wanted to go back.
When I was in Gaza, the UNICEF Executive Director Cathy Russell and I met a 16-year-old girl in al-Nasser Hospital in Khan Younis in Gaza who was hit by shrapnel in the back and who will never be able to walk again.
These children should not be going through this. We live in a world where we need to do everything possible, work with every fiber in our body so that children like that don’t have to go through these kinds of situations.
http://www.unicef.org/press-releases/2024-looms-increasingly-bleak-children-affected-armed-conflicts-and-disasters-unicef http://www.unicef.org/press-releases/unicef-executive-director-catherine-russell-remarks-launch-unicefs-2024-humanitarian http://www.unicef.org/appeals
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