Health Services As an Instrument of International Politics

International Federation of Red Cross and Red Crescent Societies

Permanent Observer to the United Nations in New York

Michael Schulz

Deputy Permanent Observer/ Deputy Head of Delegation

Health Services as an Instrument of International Politics:

Addressing Pandemics, Disasters and Violent Conflict

Global Health Studies Program

University of Iowa

October 20-22,2006

Panel on:

Linking Health Care and International Politics:

Doing Good for the Benefit of All Players

Check against delivery

Chair/Chairperson, Dear …….

On behalf of the IFRC, the International Federation of Red Cross and Red Crescent Societies, and the Permanent Observer Delegation to the UN in New York, I thank the organizers for the invitation to attend and to contribute to this conference.

The overall theme of this conference:“Health Services as an Instrument of International Politics: Addressing Pandemics, Disasters and Violent Conflict”is as relevant and important as is the topic of this panel“Linking Health Care and International Politics: Doing Good for the Benefit of All Players”. It is timely to discuss under this theme and to discuss this topic because they address issues that are acute to the global humanitarian agenda.

Allow meto develop my thoughts, but also for us to depart from the same level of understanding, to start with a few words on the theme and then the topic:

On the conference’s theme:

Firstly,there are disasters and conflicts and when it comes to an overlap of a disaster and a conflict humanitarians commonly address such a scenario as a “complex emergency”. For obvious reasons such complex emergencies are different from “simple” disasters or “simple”conflicts. They are much more complicated in terms of humanitarian needs and humanitarian approach. The scenarios in Indonesia or Sri Lanka following the Tsunami or the Asian earthquake, affecting Pakistan and India, fall under the category of complex emergencies.

Secondly,does it perhaps sounda bit like a tautology when we talk about “violent conflict”? Can we separate violence from conflict(?) even if we are only referring to potential violence or a potential conflict ?

By referring to potential conflicts I am also referring to situations of “occupation” or “sanctions”.

But there are of course conflicts and conflicts and they can be very different in terms of what their causes and who the conflicting parties are and in terms of the scale and intensity of the violence with which conflicts escalate.

Thirdly, often overlooked but nonetheless important are “chronic emergencies” and “forgotten or underfunded emergencies”. The Chernobyl disaster or the situation of Palestinian refugees fall under the first, the situation in northern Uganda under the latter category. Some emergencies turn chronic and forgotten.

Fourthly,I would like to add so called “global trends” to the list of phenomena that represent actual disasters or have a very significant potential for humanitarian disasters to come. The theme names pandemics as one global trend per se but I would also like to stress the importance of others.

The environment, “environmental change”frequently referred to as “climatechange”as well as more generally “environmental degradation” are humanitarian issues of rapidly increasing concern.Scientists have pointed out the causality between environmental change and the higher frequency of devastating storms, floods, droughts or the growing scarcity of drinking water as well as negative impacts on health. There seems to be a consensus building that action has become imperative.

The humanitarian relevanceof the subject nowadays isdemonstrated in a film by a former Vice President of the United States, entitled “An Inconvenient Truth”, which is only the most recent of many alarming reports on the disastrous implications of climate change as a global trend.

Many are looking forward to the publication of the next report by the International Panel on Climate Change (IPCC), worried that it will reveal still worse findings on the global impact of climate change.

Other global trends with very serious, potentially disastrous and obvious humanitarian implications are “poverty and inequality” or “migration” with terrible humanitarian side effects such as human smuggling or human trafficking and sexual abuse.

All those different scenarios and global trends have a humanitarian dimension in common that is not exclusively butalso defined by their increasingly serious implications on every human’s health.

Secondly, a few words on this panel’s topic:

It could perhaps be misunderstood to talk about: “Doing Good for the Benefit of all Players”.

TheIFRC does not seek to directly benefit any party except for the vulnerable and the most vulnerable. We target those at risk without capacity to cope or means to manage those risks and those vulnerable that have fallen victim to pandemics, disasters and emergencies of various kind,or conflict or complex emergencies or environmental change and degradation, poverty and inequality or the negative effects of migration.

This is not withstanding that we always seek the vulnerable and victims to determine what their needs are and what humanitarian support they require.It is an inclusive approach guided by the humanitarian principle of impartiality, various policies and ethical codes.

The permanent grass root presence of Red Cross and Red Crescent Societies, through its networks of local branches or chapters and volunteers, is a comparative advantage that allows to ensure a high degree of self- determination by the vulnerable and victims. To this extend the vulnerable and victims are indeed “players”.

A major problem with regards to the vulnerable is the fact that the risk factors which determine their vulnerability status have multiplied by a factor X resulting in continuous and rapid changes of vulnerability patterns. An individuals identity is increasingly determined by his or her vulnerability status, which in turn is determined by a measure of humanitarian risks and the capacity or lack thereof to cope and to manage those risks..

Who are the other players? I shall return to the question of who the other players or the “humanitarian actors” are a bit further on. Allow me in the meantime one more word on the theme and the topic with reference to health and international politics.

Health is for reasons that I believe are self-evident a humanitarian priority concern. Problems to health are an immanent part to most humanitarian scenarios. More often than not humanitarian work is a matter of life and death. Humans are simply most vulnerable in terms of their health status.

The IFRC deals with a wide range of health issues: public health and community based first aid; mother and child health care; emergency health and field hospitals; ambulance services; blood transfusion services; different strategies on polio, measles, malaria, tuberculosis, HIV/Aids, Avian Flu and more.

International politics, traditionally,were multiple relations between a number of states and between regions, direct relations between states and in inter-governmental fora.

It is perhaps correct to say that this concept of international politics has been outgrown by the fact that issues havegone global as is manifest in global trends.Global trends today span the global level and communities and individuals, hence the reference to the global village. States or rather their governments are not full partners in this equation. Governments are no longer in undisputed control andinternational politics are no instrument to control global trends. Governments and their national politics have to adapt to new realities instead of defending the status quo ante.

That is not to say that traditional international politics are to be discontinued. They are not. There is still much more continued reference made to: the international community as opposed to: the global community. This is a reflection of today’s political reality. The international community is deeply divided over the question what could and should constitutea global community and global unity. There are many political and other divides, not least between developed and developing countries, and in some respects these divides are widening and deepening.A comprehensive global policy has not yet arrived.

In spite of deep divides, in 2000, the global community seemed united for the moments it took to adopt the Millennium Declaration, outlining an eight goal global strategy to combat – amongst others – poverty and hunger, HIV/AIDS, malaria and other diseases, to reduce child mortality, improve maternal health or ensure environmental sustainability by the year 2015. But again, only six years later, the divides seem to prevail, achievable goals - I’m afraid to say – have mutated into visions that will not be achieved.

At the core of those divides lays the democratic principle of sovereignty. At the United Nations, a truly global, intergovernmental forum, one at which the IFRC is accredited as a Permanent Observer, a forum that has opened its doors to in-depth-consultations with civil society NGOs, analysis shows that all ongoing discourses ultimately centre around sovereignty as the key issue with too much focus on perseverance

It is difficult to predict any solution. Given increased, acute and pressing humanitarian needs worldwide some are thinking aloud to create new mechanisms for humanitarian interventionism. That could turn out to be a risky game. Some seem to suggest to embed sovereignty over humanitarian affaires, at least partially, in some global entity, existing or otherwise.

But I don’t want to stray further into visioning. Important is the fact that humanitarianism needs to be upheld, it is in higher demand than ever and there needs to be a secured “humanitarian space” for its accommodation.I will come back to that in a minute.

Allow me now to return from the visionary to the reality of our panel and continue by sharing some more thoughts on who the players and their different roles and functions are.

As a norm it is a state’s constitutional privilege and obligation to provide health services as public health or emergency health services. They are central to most, if not all, governments’ political programs and while still primarily a government responsibility, they are also at the core of the mandates of many actors in the humanitarian sector. But as a principle humanitarian mandates recognize and compliment the government’s primary mandate. They, the humanitarian actors, do not seek to assume government responsibility.

By the way, as for the IFRC and with regards to its mandate, it was President Woodrow Wilson of the United States, who first suggested the creation of a League of Red Cross Societies (today’s IFRC) alongside the League of Nations (today’s United Nations). The former – so the President suggested - to be mandated to promote health, prevent disease and mitigate suffering throughout the world, the latter mandated to address political post war issues and to secure peace.

Many governments are making serious efforts and some succeed in advancing their national health services, be it public health or emergency health services.Still, too many have not yet achieved desired and achievable standards.In extreme cases there are failed states with no health services and,as mentioned, many states struggle with the implications of global health trends, at times not for lack of will or knowledge, but because of the sheer size of the challenges at hand.

As the world population grows and poverty increases because inequality gaps are widening, the numbers of most vulnerable keep raising. Often entire population segments are affected. The numbers have reached demographic dimensions challenging the humanitarian sector not to substitute government responsibilities.

I have referred earlier to the multiplication of humanitarian risks and the exponential increase of those rendered vulnerable and most vulnerable. In this context it should not be overlooked that in numerous countries – intentionally or not – the restrictive application of international humanitarian law and human rights as well as serious gaps in local legislation are factors that contribute to risks and vulnerability.

Calling upon military services to address an humanitarian situation, especially in conflict situations, can seriously compromise the neutrality and impartiality of humanitarian actions.

At the same time there is little doubt in my mind that politics is of dual purpose and seeks, besides the sole purpose of health delivery, also political gains. To some extend this is legitimate.

However, health is an extremely complex challenge and political advantage can easily be out weight by risks.It becomes critical when health is instrumental to politics to an extend that is exclusive and disregards the complimentarity and auxiliarity of “independent humanitarian action”and “independenceas a humanitarian principle”. I will say a few more words on “independence” in a minute. Butideally the respect for and recognition of mandates should be mutual.

Lets assume above made clarifications and implicit premisses are agreeable. I would then,before ending with a conclusion, want to still say a few words aboutthe three outstanding issues that I had referred to earlier:

-Who are the the humanitarian actors?

-What is an humanitarian space ?

-Why isthere a need for independence in humanitarian action ?

I have touched upon the responsibility of governments and their prime mandate in addressing humanitarian issues as distinct different from mandates of humanitarian actors as auxiliaries. In reality it is not easy to define who humanitarian actors are because there is no clear definition of what the so called humanitarian sector is.

At present there is a discussion underway referring to the humanitarian sector as “global humanitarian platform”, comprising of three humanitarian pillars: the United Nations, the International Movement of Red Cross and Red Crescent and non-governmental organizations, NGOs.

The United Nations is an inter-governmental forum, a truly global forum with 192 states as members. This is were the discussion is being held in the wider context of UN reform and humanitarian reform. The United Nations system also comprises UN specialized agencies such as UNICEF, UNHCR, WHO and many others, united under the United Nations Charter.

The IFRCis an international organization sui generis, comprising a membership of 185 National Societies, including the American Red Cross, all recognized by their governments, by decrees or by parliamentary acts of law, Red Cross laws. In return for the recognition of RC’s humanitarian principles RC commits to auxiliarity.

The same governments that are members to the UN are participants to the 4- yearly held International RC Conference. The next Conference will be held in 2007, November, in Geneva, Switzerland. As said, the IFRC is since 1994,per resolution by the UN’s General Assembly, accredited as Permanent Observer to the UN.

NGOs, non-governmental organizations, are the third pillar. They are vast in numbers and extremely diverse in purpose. NGOs are sometimes simply referred to as civil society. The proliferation of NGOs during the past decades has made it difficult to maintain an overview and challenges cooperation and co-ordination, though many have gathered under so called umbrella organizations that represent them.

Those are the humanitarian players or three pillars working to establish a humanitarian global platform as the basis for better cooperation with governments while also striving for better coordinating amongst themselves.

Indispensable for improved interaction with governments and more efficient delivery of humanitarian services is a - not only more secured - but guaranteed humanitarian space. There are two pre-requisites: one, humanitarian workers must be safe and secured in any humanitarian scenario; two, humanitarian space must provide for safe and secured access to the most vulnerable and victims by humanitarian actors and, vice versa, the most vulnerable and victims must have access to humanitarian actors.

This leaves one principle pre-requisite to be met: subscribing and committing to their respective humanitarian principles, for the IFRC neutrality and impartiality amongst others, humanitarian actors must be granted independence of their humanitarian action.

Finally,I would not dare to draw a final conclusion.Instead I am operating – from a humanitarian perspective - with a working hypothesis under progress:

Traditional patterns of vulnerabilityrapidly change under our watch, on an unprecedented scale. Traditional coping mechanisms either do no longer exist or have been rendered insufficient.The management of global risks can no longer be subjected to national or even international politics alone. In a globalized, interdependent world humanitarian risks are to an increasing and irreversible extend only manageable on a global scale, based on guaranteed humanitarian space and independent humanitarian action.

The issues are complex and complicated. I hope I have neither convoluted things too much nor over simplified. It will require enhanced engagement by all of us - in particular also academia - to develop a better future understanding of how vulnerable humans are and how to manage risks to the better for all.

Thank you very much.

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