Correspondence

Open letter to the UN’s and guaranteed to anyone, anywhere being dependent on costly imported new health chief from in the world. pharmaceuticals to becoming a drug Women are particularly vulnerable exporting country with affordable Published Online “Alternative Nobel in times of conflict. The scourge of for its citizens—all thanks to a July 7, 2017 sexual violence has ravaged all parts visionary health-care reform. http://dx.doi.org/10.1016/ Prize” laureates S0140-6736(17)31818-4 of the world. In the Balkans, where the The excuse we hear very often is We congratulate Tedros Adhanom war ended more than 20 years ago, that WHO is, like all UN agencies, in Ghebreyesus on his election as Director- rape survivors are still grappling with the hands of the governments that General of WHO—a job that literally trauma and stigma. In Eastern DRC, may lack political will. But consider makes the difference between life and rape has been widely used as a weapon just one example: in 2008, the Italian death for millions of people around of war, and conflict-related sexual non-governmental organisation the world. violence is still widespread.3 secured the commitment As health professionals working in Despite several international res­ of 11 African governments to provide some of the most fragile countries olutions, conventions, and guide­lines, health services free of charge for all and and contexts—from health care for women in post-conflict allocate adequate human and financial to the Democratic Republic of the situations is clearly deficient, largely resources to achieve that.5 Surely, WHO Congo (DRC) and from the Occupied unqualified, and often neglected. and its Director-General have much Palestinian Territories to Sudan—we Providing adequate help and sup­ greater clout. would like to share our thoughts on port to survivors of sexual violence Somehow the idea that high-quality what we believe is at stake and where must be a common concern of all health care should be available to all WHO should put the greatest effort in medical personnel—from surgeons people free of charge—especially in low the years to come. to mental health professionals—and and middle-income countries—is still What we are seeing today around especially international agencies considered utopian by many. When the world is a double standard in such as WHO. Training in gender and Africa’s first-ever centre offering free health care. On the one hand there is a trauma-sensitive health care can opened in Khartoum, modern, efficient, and patient-centred professionalise the field and change Sudan, 10 years ago, it was considered medical system that can be credited the attitudes of health-care providers, almost an extravagance, even though with many advances of the recent as medica mondiale’s experience of WHO reports that 80% of deaths from decades, such as a marked increase in helping over 70 000 women and girls cardiovascular diseases occur in low life expectancy. On the other hand, in war-torn countries shows. and middle-income countries.6 When we witness a total lack of access to Meanwhile, measures to ensure Panzi Hospital in DRC pioneered the the most basic health care, a dearth the sexual and reproductive rights holistic treatment for survivors of sexual of qualified medical professionals and of women are being axed from the violence, it set a new standard for the facilities, and a profound disregard budgets in Afghanistan and the USA global health community. for human suffering—be it physical or alike. In Afghanistan, where four out Over the next few years, WHO will psychological. of five weddings take place without the undoubtedly face many challenges, Sometimes, these two systems consent of the bride,4 many girls and from new health emergencies to are found side by side. For example, young women see suicide as their only possible funding cuts. As Director- Palestinian and Israeli prisoners receive escape from forced marriage or sexual General, Dr Tedros will have to navigate health-care services that are light years abuse. complex political and corporate behind those that serve citizens outside WHO must work with its sister UN interests. We count on him to be a prison walls.1 Refugees fleeing conflict agencies, particularly UN Women, UN strong voice for the most vulnerable to European countries like Italy are, Office on Drugs and Crime, and the men, women, and children, and to in practice, denied the right to health Office of the UN High Commissioner ensure that no one is left behind when it care guaranteed under the country’s for Human Rights, to prevent sexual comes to advancing global health care. 2 constitution. And the poor everywhere violence and hold those responsible We are past laureates of the , are the hardest hit. to account. In doing so, it must also also known as the “Alternative Nobel Prize”. We As more and more people are recognise the vast expertise of local declare no competing interests. becoming displaced due to wars, medical personnel and women’s Sima Samar, *, conflicts, and environmental disasters, networks. , Ran Goldstein, WHO must develop and implement a In building strong, responsive, global standard for refugee and migrant and resilient health systems, local [email protected] health services. Health care must be solutions do exist. In less than Afghanistan Independent Human Rights recognised as a universal human right 40 years, Bangladesh went from Commission, Kabul, Afghanistan (SS); Emergency,

www.thelancet.com Published Online July 7, 2017 http://dx.doi.org/S0140-6736(17)31818-4 1 Correspondence

Milano 20127, Italy (GS); Medica Mondiale, , Germany (MH); Physicians for Human Rights, Tel Aviv, (RG); and Panzi Hospital, Bukavu, Democratic Republic of the Congo (DM) 1 Physicians for Human Rights Israel. IPS’ Budget Leaves Prisoners without Healthcare. July 13, 2016. http://www.phr.org.il/en/ips- budget-leaves-prisoners-without- healthcare/?pr=56 (accessed June 22, 2017). 2 Emergency. Activity Report 2012. 2013. http:// www.emergency.ch/resources/ Emergency_2013_activity_report.pdf (accessed June 22, 2017). 3 Bourke J. Rape as a weapon of war. Lancet 2014; 383: e19–e20. 4 Hasrat-Nazimi W. Suicide as a final resort. Qantara.de. May 6, 2013. http://en.qantara.de/ node/1366 (accessed June 22, 2017). 5 Emergency. Emergency’s manifesto for a human rights based medicine. 2008. http:// www.emergency.it/manifesto-for-a-human- rights-based-medicine.html (accessed June 22, 2017). 6 WHO. Cardiovascular diseases fact sheet. September, 2011. http://www.wpro.who.int/ mediacentre/factsheets/cardiovascular_ disease/en/ (accessed June 22, 2017).

2 www.thelancet.com Published Online July 7, 2017 http://dx.doi.org/S0140-6736(17)31818-4