Contributing to peace and security

At the intersection of health and peace, efforts to mitigate the effects of armed conflict on health include humanitarian ceasefires – for example, to allow immunization campaigns or other health interventions to take place. A good example is the collaboration of UNICEF, WHO and the Roman Catholic Church (later joined by Rotary International and the ICRC) to negotiate various ceasefires in El Salvador from 1985 onwards, which made it possible to immunize around 300 000 children every year. This example has often been cited in the context of “vaccine diplomacy”.

The work of WHO on health security has expanded, especially of late in the wake of the COVID-19 pandemic. The Organization’s successful efforts to tackle the Ebola epidemic in the Democratic Republic of the Congo, which began in August 2018, were long hampered by the fact that the outbreak occurred in a war zone. Several health workers have been killed by rebels in that region, and health facilities and medical personnel are increasingly subject to attack in other areas of the country affected by military conflict. Although no sustainable solutions have been found yet, it is becoming clearer to the global health community that, in some crisis situations, cooperation with the military can be as important as cooperation with the humanitarian sector. Armed conflicts and the accompanying human rights abuses pose a significant challenge to both health and humanitar- ian diplomacy (see Box 6).

economies and to the multilateral climate caused by the COVID-19 pandemic. Vaccine availability and distribution might play a major role.

A highly contentious issue in global health diplomacy is the use of embargoes and economic sanctions, which are tools of foreign policy. They not only lead to a decline in economic activity but often also have a significant health impact, especially on vulnerable population groups and inno- cent civilians. Proposals have been made to find ways of ensuring that such “economic warfare” is guided by the principles of humanitarian international law so as to mitigate the effects on civilians.

This involves monitoring the impact of sanctions, particularly with regard to water purity, food availability and the control of infectious diseases.

Box 6: Humanitarian diplomacy and health

Humanitarian diplomacy aims to mobilize public and governmental support and resources for humanitarian operations and programmes, and to facilitate effective partnerships for respond- ing to challenges and meeting the needs of communities in fragile settings.

The International Federation of Red Cross and Red Crescent Societies (IFRC) is the world’s largest humanitarian network; it helps communities worldwide to be safer and healthier and to respond to and recover from crises more effectively. Founded in 1919, the IFRC comprises 192 National Red Cross and Red Crescent Societies and is guided by seven Fundamental Princi- ples: humanity, impartiality, neutrality, independence, voluntary service, unity and universality.

These principles underpin the IFRC’s humanitarian diplomacy at all levels.

By engaging in humanitarian diplomacy, the IFRC is living up to a responsibility emanating from the important role of Red Cross and Red Crescent National Societies as auxiliaries to the public authorities in the humanitarian field. This responsibility further reflects the international status of the IFRC and the global reach of its members’ humanitarian and development activi- ties, carried out at the community level by over 14 million volunteers.

Humanitarian diplomacy consists of a range of activities designed to change mindsets and ul- timately to improve the well-being and resilience of individuals and communities, particularly the most vulnerable living in humanitarian settings. These activities include:

Profile-building: achieving widespread understanding of, and gaining the appreciation and trust of policy-makers, partners and the public for, the role, achievements and working meth- ods of Red Cross and Red Crescent National Societies and of the IFRC network as principled humanitarian actors;

Public diplomacy: influencing public behaviour so that individuals and communities take the

steps that are available to them to safeguard their health, strengthen their resilience to crises, and build peaceful, caring and inclusive communities free from any sort of discrimination; and

Influencing States and other actors: influencing policy-makers at the domestic, regional and global levels to uphold, adopt or enforce new or updated decisions, laws, policies and practices that promote the safety, well-being and resilience of vulnerable persons and enable the work of National Societies, particularly in humanitarian settings.

Humanitarian and health diplomacy often intersect in the work of IFRC at various levels. While diplomacy at the global level (for example, in multilateral institutions) addresses issues of glob- al concern (such as advocating universal health coverage), humanitarian diplomacy and health diplomacy at the national level are critical to the delivery of health programmes for the most vulnerable through complex partnerships.

Response to the Ebola outbreak in the Democratic Republic of the Congo

Throughout the Ebola crisis in the North Kivu and Ituri provinces of the Democratic Republic of the Congo from 2018 to 2020, the Red Cross was operating in a highly volatile environment characterized by mistrust towards health personnel, frequent violence and targeted attacks against front-line responders, including Red Cross volunteers.

Gaining access to and trust within various communities affected by Ebola was a long-term ef- fort that involved regular consultations and negotiations with public authorities, local armed groups, partners and communities.

The Red Cross of the Democratic Republic of the Congo was able to educate communities, isolate Ebola patients, trace and monitor anyone who had come into contact with an infected person, and provide safe and dignified burials for those killed by the disease. Many volunteers risked their lives in the front-line response and faced violence and discrimination within their communities. It was the trust of local communities, obtained through a combination of human- itarian and health diplomacy, that ultimately led to the chain of transmission being broken.