International Diplomacy and Governance During the 70th WHO World Assembly: Who Is Responsible for Refugee Response?
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Three year old Syrian Alan Kurdi washed up on Turkey’s shores on September 2nd, 2015. His family’s application to the Department of Citizenship and Immigration Canada was rejected.
Five year old Omran Daqneesh was photographed in an orange ambulance seat after the Aleppo airstrike, staring lifelessly into the distance, covered in dust and blood. These children have tragically become icons of the Syrian refugee crisis and over the past several years, greater media coverage, international outcry and awareness has brought the Syrian crisis into the international spotlight.
According to Filippo Grandi, UNHCR High Commissioner, “Syria is the biggest humanitarian and refugee crisis of our time, a continuing cause of suffering for millions which should be garnering a groundswell of support around the world” .
Numbers of refugees and internally displaced individuals according to a 2016 snapshot attribute generate a grand total of 13.5 million in need of humanitarian assistance. Greece, particularly, has received greater funding than any humanitarian response, with incoming funds from countries, private sectors and individual donations . Furthermore, there has been great civil society support including various non-governmental organizations and volunteers on the ground.
Consequently, the 70th World Assembly became the ideal setting for dialogue between various governmental, civil society and international communities to explore the interactions of these three sectors to ultimate grapple with, “Who is responsible for the refugee response?” What role (and how great) does one sector play in refugee aid and funding? How much responsibility should the international community have? Who (or what factors) are at fault in the failure of proper refugee response? These questions were explored through country delegate and health minister conversations, organizational meetings and also independent research on successes and failures in Syrian refugee response.
On paper, the United Nations and its member states are supportive of strong, positive refugee response with refugees defined as a person who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country” *  . In Article 14 of the Universal Declaration of Human Rights in 1948 , member states recognized the rights of persons to seek asylum for persecution in other countries. In 1951, the Status of Refugees  is the centerpiece of international refugee protection today.
As one of the core elements of the mandate, United Nations High Commissioner for Refugees (UNCHR) was created to advocate for the rights of refugees. It functions alongside the World Health Organization with a global health cluster in the WHO Emergency Operations Department. This ‘health cluster’ model essentially coordinates the efforts of various groups to relieve suffering and save lives. It includes a people-centered approach, collective action, supporting national authorities, and strengthening of capacity. Refugee response with respect to the UN includes this cluster, UNHCR, UNICEF which operationalizes its goals (such as clean water and emergency vaccination), Institute of Migrants (IOM), and UNOCHA which works with programming. According to a staff member working for Emergency Operations Department, the UN is analogous to “herding cows” in a humanitarian response.
On a member state level, governments that have incoming refugees (called entry states) are responsible for ensuring compliance with asylum law and prevent their departure. The first day of the World Health Assembly started to discuss various approaches that countries have taken to refugee response. Particular focus will be placed delegate conversations from countries that are responding to Syrian refugees, including Greece, Germany, Turkey, Lebanon and Jordan.
As one of the first plenary meetings on sustainable development goals, Turkey and Lebanon voiced concerns on the strain refugees were placing on their health systems. They both advocated for greater international support. Turkey has spent six billion of its own money on refugees, called for higher-income countries to take on more responsibilities, and also advocated for a stronger WHO that could advocate for the refugees. Similarly, Lebanon delegate recalled how the refugee crisis has increased the Lebanese population by 30%, with an estimated 1.5 million refugees during its peak. Both of these small countries are strained and pushed to their limits to meet healthcare demands of both locals and refugees.
Upon a closer, more personal conversation regarding refugees in Turkey after a side event, Dr. Oner Guner, General Director of the Republic of Turkey Ministry of Health, commented on the country’s compassion towards refugees. He recalled how, “when 100,000 individuals knocked on its door, it was impossible to remain unconcerned”*. Dr. Guner emphasized that if they were not taken in, these individuals would die the next day. When asked why his country took them when other haven’t, he shared how his citizens have humanity and have come together with respect to caring for refugees. He shared an example of how individuals are spending less on luxurious expenses (such as eating out at restaurants) and instead putting those funds for refugees, with an estimated 25–26 billion spent on refugees. He contrasted this with international financial response which was less than 1 billion, with 700,000 thousand from the European Union, 550,000 thousand from the UN. He ended our talk with, “Turkey is not a rich country but has a sense of humanity and mercy”*.
Another country that has possibly performed the best with integration of refugees into its country is Germany. After several (failed) attempts to talk to delegates during the first week, one of the lead delegates walked into a NCD alliance side event and was promptly questioned during the reception. Garrett shared that it was relatively easy for 1 million refugees to become a part of its 84 million Norian citizens. They were just a “small part”*. When asked factors that influence such a positive response, he shared that it was due to: strong leadership, empathy of the people, large population size, strong economy and a national history that encouraged empathy and humanitarian response. When asked about operations, he spoke on a federal system with a coordinated structure and orchestrated efforts including welcome centers, refugee registration, work permits and review of policies to reduce the time individuals cannot work upon arrival. In other words, this country had a strong economy, was prepared and was empathetic to incoming refugees.
Greece, in contrast, was the opposite. At the beginning of 2015, there was no mechanism or capacity to compel new arrivals or set “hot spots” on the eastern Aegean islands of Lesbos, Kos, leros, Chios and Samos. Furthermore, Greece has infamously shown the worst response to refugees with civil unrest and resentment towards incoming refugees. Some Syrian refugees regret coming to Greece due to extensive waits for refugee applications to be processed . There is talk of camps being purposely lit on fire to drive refugees away. After a few sessions of loitering outside of Committee A to meet the delegate of Greece, she commented she did not time. Eventually, another delegate strolled through Serpentine and was questioned about refugee response. He changed attitudes fairly quickly on that topic. Initially warm and friendly (asking, “Are you from Greece? You can pass for Greece!”*), encouraging me to ask him anything, he essentially said no comment on the Syrian refugee crisis. He said his country “has done as much as it can”* . He referred me to online press releases and refused to discuss the situation further, stating he needed to talk to his friend. He refused to give his business card.
This silence was echoed throughout the assembly.
Syrian refugees were almost a taboo topic that was discussed briefly and sporadically throughout meetings. The Deputy Director of UNAIDS shared the same frustration and feelings when he commented (with profanity) how the Syrian refugee crisis is not being discussed or addressed.
Key pockets in Committee A shared the following realities in Syria: dire conditions in Syria with torture tactics forcing (potentially false) confessions from individuals, using prisoners as guinea pigs for new drugs, and deprivation of human rights in Syria . Throughout many countries, there was a call for action for the international community to respond and end the suffering of this population.
As of May 26th, 2017, there was no official comment on the Syrian crisis or any response, discussion or plan.
In the words of Dr. Guner, the world has become “deaf and dumb to the Syrian people”* .
One notable civil society member, Doctors without Borders, also shared this same frustration with WHO’s limited response and/or capabilities. Dr. Joanne Liu discussed the work her independent, private sector group is doing within Syria in terms of medical response. She shared her concerns for her staff as recent hospitals have been points of attack, although all the governments had previously, by majority, agreed that hospitals would not be attacked. She is moving the organization into a more cohesive, integrated approach by fostering partnerships with the military and also the United Nations. She also commented how her organization was able to stay true to its mandate of ending suffering by being financially independent.
Other civil society organizations are not in that situation. Many NGOs accept private sector donations which have strings attached. Much of the international aid funds have been allocated towards international agencies rather than the government. A glaring weakness in the presence of various NGOs responding to refugees in Greece is that there is no accountability. Each group can be working independently on its own agenda with no supervision, cooperation or accountability. According to Refugees Deeply, there is an estimated $654 million from the European commission, the Greek government received $188 million, further $185 million went to organizations dealing with refugee protection, asylum and migration10. According to Lora Pappa, head of Metadrasi (a Greek organization assisting refugees), the large influx of money transformed refugees into “commodities” and encouraged short-term actions11. These groups compete for funding, compete with one another in terms of services and ultimately, the refugees are the one paying the cost.
As a prime example, UNHCR showed this dynamic of donor-recipient relationship when it operated within the European Union, its biggest donor, to advocate for refugee rights. According to Fotini Rantsiou, a U.N. staff members, “instead of advocating for the protection of refugees, they remained silent for fear of political consequences. Even if the wanted to criticize policy which violates principles, they could not” 12.
The first and predominant recommendation shared across several entry states was a general call for action for a stronger WHO that could advocate for refugees. Although there were several mentions across committee meetings, there was limited discussion regarding Syrian refugees. The only mention close to Syrian refugees was on Item 19 on May 31st on the Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan. Item 13.7 on promoting the health of refugees and migrants would be discussed (wasn’t) if time permits. A few side events discussed NCDs in migrant populations.
The responsibility should not be placed on only entry states that are already strained under pressure. The international community is ultimately responsible. As many entry states suggested, the more higher-income countries need to step up and take responsibility. Furthermore, funding should be more focused on governmental initiatives to integrate citizens into society rather than funding long-term refugee camps which exacerbate trauma and neglect. Research in different refugee response has shown that nations that integrate refugees quicker and more fluidly into their host countries (i.e. Germany and Uganda) have a more positive refugee response than countries that rely predominantly on creating and sustaining refugee camps.
Additionally, there is a casual relationship between economies and refugee response. Greece is a prime example of failed refugee response due to a failing economy. Ultimately, a strong economy fosters a stronger, healthier population, according to several organizational messages (such as the Gavi Alliance). The overarching goal for WHO is to eliminate suffering, rather than just deal with the symptoms. According to Dr. Douglas Webb from UNDP, the World Health Assembly is really the World Sickness Assembly13 as it culminates the failures of nations to promote healthy lives. Similarly, another individual, Dr. Akihiro Seita voiced similar concerns of addressing root causes of conflict to effectively promote health. According to his article, No health without peace: why SDG 16 is essential for health, he mentions that peace is a non- negotiable attribute to ensuring a healthy, productive global population. Specifically with respect to Syria, “life expectancy has been reduced by 20 years, 80% of the country’s population is now living in poverty, and economic losses are estimated at more than US $200 billion” .
Dr. Seita essentially says, “Politics and health are inextricably linked” .*
The greatest failure of WHO with respect to refugee response is its neglect of politics in the pursuit of health. Its primary focus is shifting to NCDs and long-term care, rather than addressing mass killings, tortures, drowning, and attacks upon Syrian citizens. Dr. Guner summarized these findings perfectly when he commented:
“How inefficient it is for the UN to focus on vaccinations, food, aid, and water sanitation for refugees rather than preventing the deaths from happening in the first place.”*
Just like how physicians address symptoms of disease and neglect prevention, the UN and its member states deal with the symptoms of war and conflict with their mandates and coordination. The absence of an actual discussion of politics, an assembly wide silence, and the adoption of the Syrian response as a taboo topic that is not being put on the agenda and discussed openly, solidifies the limitations and ultimate shortcomings of the United Nations with respect to the health of the most vulnerable and desperate. The United Nations will never fulfill its mandate of alleviating the suffering of the world if it fails to acknowledge the linkage between politics and health.
*Note: Quotes are from personal communication at the 70th WHA
7 Greek Delegate. May 26th, 2017. Serpentine at UN.
8 Committee B. Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied
Syrian Golan. Wednesday, May 31st. 2017
9 Dr. Oner Guner. May 23rd, 2017. Stronger national health systems underpinning stronger health security. Organized by the delegations of Australia, Indonesia, Mexico, Republic of Korea, the Philippines, Turkey and the United Republic of Tanzania.
Oner Guner. May 23rd, 2017. Stronger national health systems underpinning stronger health security. Organized by the delegations of Australia, Indonesia, Mexico, Republic of Korea, the Philippines, Turkey and the United Republic of Tanzania.