December 10, 2023, marks the 75th anniversary of the founding commitment of the modern human rights movement, the Universal Declaration of Human Rights (UDHR).
Seventy-five years on, the world is tested and tormented by an agonising array of conflicts in which human rights violations are not secondary outcomes, but rather central to such conflicts.
Ethnic cleansing, collective punishment, apartheid, sexual violence as a tool of state terror, and the deliberate targeting of health care facilities and workers are part of multiple ongoing conflicts in 2023.
The unprovoked Russian invasion of Ukraine in 2022, civil conflicts underway in Tigray in Ethiopia, Sudan, Myanmar, and Syria, the conflict between Israel and Hamas in Gaza, and the Saudi-led coalition’s bombardment of Yemen, all have in common violations of the rules of conduct in war — specifically, attacks on civilians, health care workers, health care facilities and infrastructure, and other violations of medical neutrality.
These attacks are also violations of the right to health; through the denial of health care access, they undermine the principle of dignity and the equal value of all human lives.
Armed conflict is an extreme domain of human rights abuses, but is only one of many settings in which human rights violations are taking place.
Other concerns that undermine the right to health include the deliberate degradation of our environments and the climate for short-term profit and the widespread use of disinformation and misinformation that adversely affects people’s rights to benefit from scientific progress.
Disinformation related to the safety and efficacy of vaccines has led to multiple disease outbreaks and to losses of life during the Covid-19 pandemic.
Political and legal attacks on the rights of sexual and gender minorities, and on the rights of women, undermine the universality of human rights, and are occurring in countries as diverse as Iran, Russia, Uganda, and the United States.
Indeed, in his opening address at the 53rd Council of the United Nations Human Rights Council in June, 2023, Volker Türk, the UN High Commissioner for Human Rights, reaffirmed the centrality of the UDHR for our deeply troubled times precisely because of its core principle of universality.
The global community backs away from the universality of human rights at its collective peril. In 1948, the UDHR was crafted in the wake of the Nazi persecutions of Jewish people, Roma, LGBT persons, individuals with disabilities, and others deemed unfit to live by the Nazi regime.
The relevance of the UDHR was also clear in the decades that followed World War Two, notably in the struggle against the avowedly racist apartheid regime in South Africa, which was also a struggle to realise universal rights.
Equality for all must be upheld as a guiding principle for all our societies. The responsibility to protect rights cannot be left to our current political systems and human rights bodies, including the UN, because they are manifestly failing to do so in many places.
How relevant, then, is the human rights framework to health in these troubled times? How can the global health community press for universal health coverage, committed to by heads of states at the 79th session of the UN General Assembly in September 2023, when we see so many millions of people denied the most basic health services, including the substantial numbers of internally displaced people and refugees?
And what are the possible roles and potential actions health-care workers can undertake to address these threats?
First, the tools of population-based sciences need to be used more intensively and routinely to document and measure human rights abuses; this information can be used to hold governments and other actors to account.
These tools, exemplified by the use of novel satellite technologies and video surveillance in the documentation of Russian atrocities in Bakhmut and other cities in Ukraine, hold great promise for accountability for war crimes.
Second, health care workers must put human rights at the forefront of our work and become much more engaged in efforts to protect the rights of those we seek to serve.
This is a pressing reality for many obstetric care providers in US states, for example, where multiple restrictions on reproductive and sexual health and rights have adversely affected the practice of medicine, endangered patients’ lives, and put health-care providers in legal jeopardy for providing essential care.
Third, medicine and health care must be a more active participant in advocacy for health care access as a human right in all societies. No one should be denied health care access by virtue of legal or immigration status — yet multiple health systems do just this, and providers must not be complicit in these denials of access to care.
Fourth, common cause is needed with those advocating for inter-related rights, including the movement for addressing the climate crisis and for climate justice, anti-racist struggles, the LGBTQ+ rights movement, and the global movement for women’s rights to bodily autonomy, choice, and freedom from sexual and gender-based violence, among others.
Health care workers have agency in these struggles and need to influence these social and political debates. Health-care workers cannot stay in our professional domains and expect others to address these crises.
To address the rising tide of human rights violations and their many and varied impacts on health, the International AIDS Society and The Lancet convened a multidisciplinary commission on health and human rights in 2019.
The commission’s report is expected to be released in early 2024. This report will aim to explore multiple domains of health and rights and will argue for a reinvigoration of the UDHR as a basis for protecting health in the 21st century.
Human rights protections are not optional, and they are not reserved for the fortunate few who are citizens of countries that now enjoy peace and prosperity.
If we consider the climate crisis alone, our collective rights to enjoy a liveable and healthy environment are under existential threat. Young people worldwide know that their survival is at stake, and many have been organising and winning court cases based on their right to a liveable future.
For those living under repressive regimes and trying to survive in the world’s expanding zones of conflict and displacement, human rights have proven stubbornly cherished hopes for a better future.
Health professionals must do everything we can to ensure that future and uphold human rights in protection of humanity’s common survival.
Prof Dr Adeeba Kamarulzaman and Chris Beyrer are the co-chairs and Allan Maleche is a commissioner of the International AIDS Society-Lancet Commission on health and human rights. This commission has been supported by the International AIDS Society and by the Desmond M Tutu Professorship at the Johns Hopkins Bloomberg School of Public Health.
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