WHA delegates spent over 10 hours in diplomatic maneuvers, debates and painful rollcount votes Friday, finally approving two measures that decried the humanitarian crisis in Gaza in sharply different, and sometimes  contradictory terms.  

One motion co-sponsored by a coalition of Algeria, Russia, China, Cuba, Iran, Egypt and other Middle Eastern allies, condemns “indiscriminate attacks” by Israel on medical and humanitarian facilities “used exclusively for humanitarian purposes.”  A second resolution approved in December at a special meeting of WHO’s 34-member Executive Board, including EU countries and the United States, called for a “humanitarian ceasefire”, using more neutral language. 

Both measures ultimately passed with large majorities – but with a raft of abstentions as well as objections on all sides of the aisle. 

The bitter, 10-hour long debate over Gaza, Palestine and Israel, followed a mere two hours of attacks and accusations around a new draft resolution over the Ukraine humanitarian and refugee crisis, with a title referencing “the Russian Federation’s aggression”.   The new Ukraine resolution proposed by European states, with United States support, won WHA approval by a vote of 72-10.  A  counter resolution proposed by the Russian Federation, Syria, North Korea and Belarus, failed to pass, garnering only 13 votes.  

It also came on a day when Palestine was awarded quasi-member state status by the World Health Assembly – in all regards except the right to vote and hold positions on the governing board or other governance instruments. [see related story]

Palestine Granted Quasi WHO Member State Status – Without Voting Rights  

First OPT decision, subject to numerous amendments by bitter rivals

The first Gaza measure, was built around a perennial, stand-alone “decision” on the “Health Conditions of the Occupied Palestinian Territory (OPT), including East Jerusalem and the Occupied Syrian Golan” that is voted on, and approved, every year by the WHA.  The long and rambling text, in fact, addresses a very mixed bag of settings, populations and health conditions.  

This year’s version called out Israel as the occupying power to address “the threat of famine” water and sanitation, and ensure adequate supplies of fuel, medicines and humanitarian aid to Gaza.  A raft of other provisions  mandate WHO to report on “wanton destruction of health facilities”; “acts of violence against the wounded and the sick and medical personnel”, and “results from the use of starvation of civilians.”  

The decision also calls on WHO and Israel to ensure “unhindered access” for Palestinians in the occupied territory including East Jerusalem, to a full range of health products and services. In fact, East Jerusalem Palestinians, are typically enroled in, and served by, Israeli health funds – although if they are not formally registered by Israeli authorities as Jerusalem residents, then access to medial services can be hampered.

However, along with the acute crisis in Gaza, West Bank Palestinians have suffered from oft-serious problems accessing services due to a tough Israeli military crackdown since the war in Gaza began. That has hindered travel to West Bank Palestinian hospitals, private or public, as well as to Jerusalem-based Israeli and Palestinian facilities that are common destinations for more advanced services, like cancer treatment.

Finally, the decision calls upon the WHO to conduct an assessment of health conditions in what it describes as the the “Occupied Syrian Golan”, where communities of Druse, an ancient Middle Eastern religious minority, have lived under civilian law, with access to Israeli health funds, since 1981.  Those Golan communities, like other Jewish, Druse and Palestinian communities in pre-1967  northern Israel, are however, facing physical risks, stress and economic disruptions from the low-level war raging in the north between Israel and the Hamas-aligned Hizbullah, based in southern Lebanon.

Technical or political?

Described by supporters as a “technical” measure, the decision was criticized by the US and some European member states, and Israel, as a largely political instrument, singling out one WHO member state amongst 194, and mixing the dire realities faced by Palestinians in Gaza and the West Bank with rhetoric unique to a single conflict.

“The decision before us today has been presented year after year since 1968. Since then, Palestinians and Syrians have used this annual ritual to attack Israel and to absolve the Palestinian Authority of its responsibility for governance,” said Israel’s delegate to the WHA.  

“It has also been used to divert attention from decades of atrocities committed by the Syrian government. This decision has never been about health. If this decision was about health, it would address the systematic and deliberate militarization of health facilities in Gaza by Hamas and by the Islamic Jihad. Health facilities in Gaza are used as hideouts and launch sites for terrorism…. Hamas is deliberately putting the safety of patients at risk. Everyone in this room is well aware of it. Evidence of this militarization was found in every hospital in Gaza and Shifa Hospital for example, there were more terrorists than patients; Israeli forces apprehended some 500 terrorist and eliminated hundreds more.” 

The decision ultimately passed but with the addition of four amendments tacked on by diametrically opposed geopolitical blocs of member states. 

Firstly, an amendment proposed by Israel, which won approval 50-54 in the surprise outcome of a member state vote Wednesday, called for the Hamas release of hostages, as well as condemning the militarization of Gaza’s health facilities.  

In response, Bahrain and 18 other co-sponsors proposed and won approval Friday for three new amendments, including one directly condemning Israel’s  “indiscriminate attacks on medical and humanitarian facilities”.  

Sponsors like Iran abstained because of a mention of hostages

As a result of Israel’s amendment, some co-sponsors of the original measure, such as Iran and Libya, ultimately abstained from the final vote on the decision, which passed 102-6.  

“Recent gross violations of international humanitarian law, particularly war crimes, crimes against humanity, genocide, ethnic cleansing, mass disruption of health infrastructure us and enforced displacement committed in Gaza demonstrates as an absolutely unleashed nature of this regime in committing atrocities in an unprecedented manner,” said Iran’s delegate. 

Others, including Mediterranean and Gulf powers, such as Egypt, Turkiye, Tunisia, and Qatar, voted for the measure but explicitly “disassociated” themselves from the Israeli-added reference to Hamas holding of hostages and militarization of health facilities.  Oman complained that the reference to calling for the releease of hostages failed to also refer to the conditions of thousands of Palestinian prisoners who have been detained by Israel before and during the Gaza war – “and are held in inhumane conditions where international representatives are not allowed to visit them.” 

European states distance from some of the decision’s provisions 

Meanwhile, a number of European nations and allies that ultimately voted for the Algerian-sponsored measure, or abstained, later sought to distance themselves from some of the stronger language condemning Israel unilaterally for the crisis in Gaza, and particularly for the destruction of health infrastructure.  

Norway, which recently recognized the state of Palestine, called both out “the misuse of hospitals for military purposes” on the one hand, a clear reference to Hamas, as well as “indiscriminate attacks on hospitals” on the other, referring to Israel. 

“Such facilities, for medical purposes, must be respected and protected in all circumstances and by all the parties to the conflict,” Norway’s delegate said.  

The United States, Israel’s staunchest ally, opposed the first, Algerian-sponsored measure, outright.

“We believe the current draft decision does not help advance the cause of a lasting and comprehensive peace between the Israelis and the Palestinians,” the US delegate said in the  debate. 

“Nothing justifies violence on any side, in any part of the world… but we are only going to get to the truth if people start speaking it,” said Argentina. 

 “If you ignore what happened on the seventh of October in Israel. If you ignore the fact that hostages were taken as a result of that, you will be politicizing a situation. You will be giving a distorted, unbalanced picture of what happened – and that will also lead to a complete and utter loss of impartiality.” he said, referring to the Hamas incursion into Israeli border communities that killed some 1200 Israelis, mostly civilians.  

‘Gazans and the people of Israel have both suffered’ 

The late evening WHA session saw the final vote on the second resolution decrying the Gazan humanitarian crisis – this one the product of a consensus reached between G-77 nations, the European Union, the United States and its allies at the December Executive Board meeting.  

But in a surprise move, the United States also abstained from voting on the EB-approved measure, due to what it said was a continuing “lack of balance” with reference to the absence of a reference there to Hamas-held  hostages. 

 “Citizens in Gaza and the people of Israel have both suffered in this conflict. Our top priority is a ceasefire agreement that leads to the release of hostages and creates conditions to facilitate a surge of additional humanitarian assistance into Gaza,” said the US delegate to the WHA in the debate that took place just as  President Joe Biden was anouncing a new US proposal for a Gaza cease-fire and hostage exchange deal.

Allegations of genocide and concerns about hostage release

In a debate that preceded a roll call vote, Turkiye, Egypt, Cuba and other bitter critics of Israel, decried what some described as a genocide in Gaza, and others, “war crimes against humanity” in the words of Cuba. 

Meanwhile, European Union delegates and allies, led by Belgium, “urged the Israeli Government not to undertake a ground operation in Rafah, which would worsen the already catastrophic humanitarian situation.”

And they stressed the importance of “respecting and implementing the orders of the International Court of Justice,” which are legally binding. 

The EU also expressed “grave concern” over the “safety and well-being of hostages held by Hamas, calling for their “unconditional release.”

Situation on the ground

Late Friday evening, and only after hours of bitter member state political sparring, did WHO’s Executive Mike Ryan, provided a brief update of the actual situation in Gaza on the ground. 

“An estimated 1 million people have left Rafah in search of safety that does not exist anywhere in Gaza,” he said, adding the recent Israeli evacuation order affects 17 hospitals including three field hospitals to the north and the loss of more than 600 hospital beds.”

 The flow of health supplies and humanitarian aid remains paralyzed due to the closure of the Rafah crossing into Gaza, following Israels take over of the area. WHO missions to embattled hospitals, particularly in northern Gaza, continue to be cancelled, impeding the flow of health aid within the enclave. 

“The health system degradation continues. The system is winding towards zero humanitarian access,” Ryan warned.

No time left for discussion of other humanitarian crises 

Aside from the discussion of Ukraine, the day-long debate left no time for discussion of more than a dozen other  acute crises and conflicts raging in the world today, defined by WHO as Grade 3 emergencies  – and the increased burden of emergency health and humanitarian needs that they have generated. Observed Slovenia’s delegate as the evening discussion on Gaza continued into the late night hours:  

“Slovenia is deeply concerned about the increasing frequency complexity and duration of health emergencies, resulting from conflicts which have led to a significant rise in global humanitarian health needs, affecting people in Afghanistan, Haiti, Somalia, Ukraine, Sudan, Gaza. And elsewhere. The growing number of attacks on healthcare facilities and personnel is unacceptable.”

Gaza transfixes WHA 

If it proved anything, the long-winding debate demonstrated the unique and enduring ability of the Israeli-Palestinian conflict to transfix diplomats, defy solutions and polarize WHO member states more than almost any other conflict in the world – captivating the hearts and minds of countries thousands of miles away from the war’s epicenter.  

Said the representative from Cook Island, the dicussion continued towards midnight, “We ae a small island state, and our primary fight is against climate change. We are17,000 kilometers away from Gaza. However, we cannot and won’t ignore the dire humanitarian crisis affecting our fellow human beings, civilians and hostages. And we will support all genuine efforts to address these issues as well.” 

In an emotional late night statement, close to midnight, and just prior to the final vote on a secod resolution, WHO Director General Dr Tedros Adhanom Ghebreyesus, directly appealed to Israel, who he said “held the keys” to a ceasefire call. 

“I ask Israel and appeal to Israel to stop this war,” said Tedros, in a voice hoarse from speaking throughout the week. “For the sake of humanity, I think the key holder should stop the war. 

“It’s in the interest of Palestine in the interest of Israel to go for a political solution,” Tedros  added, while also calling for the  “safety of the hostages, support of medical care, and of course their release.” 

Correction- The correct vote count on the amendment calling for release of Hamas held hostages was 50-44, not 54-50. 

Image Credits: OHCHR , https://cdn.who.int/media/docs/default-source/documents/emergencies/who_ghea-2022_grade3-emergencies-map.pdf?sfvrsn=7215a303_7.