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The author is a Professor and the Director of Center on Forced Displacement at Boston University
The idea that the system to protect and deliver quality healthcare to those displaced because of conflict or persecution remains broken is not particularly novel. It is self-evident now. Funding to support distressed communities has all but evaporated, and whatever fiction of international law we believed in, is no longer believable.
Yet, our attention tends to focus only on the most recent episode of conflict and devastation, putting the previous one that remains just as acute in some distant corner of our memory with a do-not-disturb sign.
This all may seem like a sudden series of events of the last couple of years, but communities that are impacted, and historians, will tell you that this has been happening for a long time. Global financing for supporting the forcibly displaced has followed donor priorities, not actual need. International law has always been applied selectively. Health of some has been advertised as critically important and the safety and well-being of others has always been invisible.
For the last two years, a group of public health experts, practitioners and researchers has been dealing with this very question: how did we end up at this point, and where do we go from here? Led by colleagues at Johns Hopkins University and the Geneva Centre of Humanitarian Studies, the Lancet Commission on Health, Conflict and Forced Displacement brought together dozens of researchers, practitioners and next generation scholars from high, medium and low-income countries from all around the world. I too was privileged to be part of the commission that asked questions that included the governance and history of the humanitarian system, the financial and political challenges we face, the disregard of local communities, the gaps in coordination, the opportunities and challenges new technologies pose and what a better system may look like. The team went through existing data, collected stories of people on the move and spoke to a variety of experts – from those who work in large organisations to those who are at the front lines. The final report came out last month and is publicly available. It proposes a set of four organising principles that include inverting power and shifting decision-making to local communities, ending impunity and enforcing accountability, aligning financial resources that focuses on need and not donor priorities, and ensuring health for all is a fundamental human right and non-negotiable.
We recognise that not only this is easier said than done, but also that some of these guiding principles will need to recognise ground realities. For example, what happens in the case when local governments are the ones targeting individuals based on faith, gender, race, political affiliations or any other discriminating factor? How does one empower the local public sector in such a case? The answers to these questions are not going to be easy, but the solution is neither to disengage nor to make decisions in fancy hotels in glittery cities far from the regions of need. Rather, it is to work with local physicians, researchers, practitioners, human rights advocates and community members who are committed to delivering care, even when, or perhaps especially when, it is politically challenging.
There are many other scenarios and questions we can imagine that are going to test the recommendations and I hope new and more refined ideas emerge from these conversations and disagreements. The report should be a floor and not a ceiling for debate, especially in this moment when so much seems to be going in the wrong direction. Our work should also be viewed in a continuum. The idea of health for all means that we protect everyone: those who are forced to flee their homes because of falling bombs, and those who are permanently stuck in the slums because the state does not recognise them as people; that we protect those who are victims of armed conflict; and that we protect the female physician performing her duties in her office in Quetta from unspeakable acts of violence. In reality, the guiding principle to reimagine healthcare is not about others we focus on, but about all of us. It is ultimately a permanent contract to uphold our values as decent and caring human beings, everywhere and always.