The WHO Executive Board voted to advance a resolution on aid to war-torn Gaza to May’s World Health Assembly, the first to be greenlighted while several dozen other initiatives remain on hold due to budget constraints. Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus appealed to Israel to allow thousands of desperately sick and injured Palestinians to evacuate via its borders, and to reconsider the shuttering of UNRWA, the massive UN relief agency for Palestinians.

The Gaza aid resolution likely holds the steepest price tag of any new measure being considered by the Executive Board (EB) this week – some $648 million for the delivery of emergency aid and the initial rehabilitation of Gaza’s shattered hospitals and health clinics.

Those costs would be covered by the department’s “emergency appeals budget segment” according to a financial analysis accompanying the report. Even so, it was unclear how the huge price tag could be squared with a projected 25% cut in WHO’s budget for its emergency operations, under new austerity measures being imposed at the global health agency as a result of the United States withdrawal from the organisation.

See related story:

Crucial WHO Health Emergency Response Faces Budget Cut of 25%

The Wednesday evening vote on the Gaza measure came after an emotional five-hour debate and a prolonged back and forth on the technicalities of voting procedures. That came after Israel, which currently holds a seat on the EB, proposed that the resolution be “noted” by the EB without an explicit endorsement due to it’s failure to call out Hamas role in the conflict and ensuing humanitarian crisis.  

Brazil and others objected. And several hours later, the new EB resolution, identical to a Gaza measure approved at the May 2024 World Health Assembly, was approved by a vote of 26 to two. Amongst the 34-member EB, five member states also abstained and one country was absent. 

At the time of the vote, WHO swivelled its live video stream away from the EB assembly, so that no one outside of the EB room could witness the vote by show of hands in one of this session’s most charged moments of decision-making.  

While the United States, Israel’s staunchest ally, was at the table for the vote, it did not speak on behalf of Israel’s claims that both the resolution, as well as a WHO report accompanying it, were  “biased” because they targeted only one party to the conflict, Israel, and not Hamas.

“Hamas is and remains the first and foremost cause of civilian sufferings in Gaza,” contended Waleed Gadban, Israeli delegate to the EB. 

“Yet the report in front of us keeps referring to effects in healthcare without acknowledging that hospitals in Gaza are used outside of their humanitarian function to store arms and ammunition, hide innocent [Israeli] hostages and commit acts on Israel and its citizens. Israel does not launch attacks in those facilities, but on Hamas personnel and on targets hiding in healthcare facilities.

“Even when, immediately after the announcement of the cease-fire, Hamas emerged from the Al Nassar Hospital complex, carrying their arms and weapons stored there, UN agencies still failed to condemn the blatant abuse,” Gadban said.     

Palestine and Arab states fiercely dispute contentions 

The EB’s delegate from Palestine fiercely disputed Israel’s contentions regarding Hamas’ role in the conflict or its militarisation of health facilities, laying the blame for the 15 month-long destruction of the enclave solely on Israel.  

“Let Palestine remind you that the Gaza Strip’s 364 square kilometres has turned from an open air prison to an open air prison to an open air graveyard for Palestinians, stripped of basic rights and hope,” said Ryad Awaja, a counsellor in Palestine’s UN Mission to Geneva, referring to Israel’s decades-long blockade of Gaza, imposed when Hamas first took control in 2007. 

“The people in the Gaza Strip enclave were stripped of their basic human rights and access to health and most importantly, and were stripped of hope of a better life and future,” he said.

 “It’s a shame that we need a UN vote to say killing civilians is wrong.  

“It’s a shame that we need to vote to say that killing health workers is wrong. It is a shame that we need a vote to say bombing hospitals and health facilities are wrong. It’s a shame that we need a vote to say starving the whole population is wrong.”

Added Egypt: “We plead for the EB not to be compromised or intimidated by some member states and their groundless and twisted allegations against health workers. Those WHO staff, who have lost their lives while fulfilling their responsibilities didn’t belong to any factions. They didn’t carry weapons, and they’re certainly not terrorists.”

Concerns about Trump’s recent statements and UNRWA’s fate

A long list of European, African and Asian states meanwhile expressed hopes that the current Hamas-Israel cease-fire would hold despite its fragility, leaving space for the daunting task of rebuilding the 365-km2 enclave, and a more lasting peace arrangement. 

Many delegates also denounced recent statements by US President Donald Trump describing how he wants to relocate Palestinians away from Gaza in order to expedite the rebuilding process and even take control of Gaza himself, something that has been staunchly opposed by countries across the region and beyond.    

“All attempts to displace the Gaza population outside is against international law,” said Spain. 

“Malaysia strongly opposes any proposal that could lead to the false displacements or movement of Palestinians that will constitute ethnic cleansing and a violation of international law,” said the country’s delegate. “Any attempt, whether direct or indirect, to unilaterally and forcefully impose solutions that disregard the Palestinians people’s right to self determination and infringe on their freedom is unacceptable, undesired, unjustifiable, and will only further deepen one of the longest conflicts in the region.” 

Norway, meanwhile, said it was “deeply concerned about the consequences of the Israeli laws seeking to prevent UNRWA from delivering services in Palestine, the implementation could have catastrophic consequences on the lives of Palestinians, including on their access to health services.” 

Will Hamas remain in control in Gaza?

On the other side of the fence, several member states, including Australia, emphasised that Hamas, which has become much more visible in Gaza again since the cease-fire came into effect on 17 January, should not be allowed to retain control of the enclave in a final settlement. 

Two conservative member states, Argentina and Hungary, echoed Israel’s concerns regarding WHO bias in its reporting on the conflict, saying that the WHO report on Gaza’s humanitarian crisis, which accompanied the resolution, ignores evidence that Hamas frequently used health facilities to hide fighters, munitions as well as Israeli captives. 

Said Hungary: “We must make sure that Hamas and other terrorist organisations are no longer in position to gain power and military Gaza through coordinated attacks and misuse of civilian infrastructure, including hospitals and other medical facilities.”

And Argentina also complained about bias in the WHO reporting on Gaza saying “It does not mention in any way the use of hospitals by armed groups as cover.. It’s a completely biased report, with a warped view of reality.” On Wednesday, the country’s president Javier Milai announced that he intends to withdraw from WHO, following in the footsteps of the United States. 

Suffering in Gaza is beyond comprehension

While the price tag of the aid to Gaza that would be delivered as part of the resolution approved Thursday is steep, it’s only the beginning. WHO has estimated that it will cost some $3 billion over the next 18 months to begin rebuilding Gaza’s shattered health system. Costs could be as high as $1o billion over several years.

To date, only 18 out of 35 hospitals are functioning, only partially, along with about one-third of primary health care centres and 11 field hospitals, Altaf Musani, WHO’s director of Health Emergencies interventions, told the EB assembly. 

“Some 12,000 to 14,000 critically ill patients, including 2500 children, require immediate medical evacuation”, he added, noting that WHO continued to encounter “significant access challenges” to medical evacuations – even after the opening of Gaza’s Rafah crossing into Egypt. 

“Some 12,000 to 14,000 critically ill patients, including 2500 children require immediate medical evacuation despite significant access challenges since the opening of Rafah.

“The suffering in the strip is beyond comprehension,” Hanan Al-Balkhy, director of the Eastern Mediterranean Regional office, told the EB. “Tens of thousands of people have died, and around 30,000 have life changing injuries. The health system is in ruins. Malnutrition is rising, the risk of famine persists. Families are returning to devastated neighborhoods, although no health facilities remain intact despite unimaginable challenges,” she added.  An estimated 85% of Gaza’s two million people have been displaced by the conflict.

“We urgently need systematic and sustained access to the population across Gaza, and we need an end to restrictions on the entry of essential supplies,” Balkhy said. “Equally critical is protecting civilians and healthcare workers, expediting the evacuation of patients in urgent need of specialised care and strengthening the referral system to [hospitals in] East Jerusalem and the West Bank.”

Tedros appeals for faster pace of medical evacuations

Meanwhile, the WHO DG appealed to Israel to enable a faster pace of medical evacuations to third countries through Israeli, as well as Egypt’s crossing points.

Between 1 and 3 February, only 105 sick and injured patients were evacuated via Egypt, a drop in the bucket of the need.  Israeli approval of transfers over its land borders have meanwhile moved at snails’ pace, even for infants with deadly genetic conditions.

In his remarks, Tedros also urged a reconsideration of Israel’s decision to shutter the Jerusalem operations of the UN Relief Works Agency (UNRWA), which has provided specialised health and education services to Palestinians since 1948. 

Israel took the move following reports that UNRWA employees had been involved in the bloody Hamas attacks on Israeli communities on 7 October. An UNRWA investigation subsequently determined that nine UNRWA workers, out of the thousands employed by the organisation, may have been involved in the attacks.   

“All of the UN agencies combined cannot replace UNRWA,” Tedros declares, and anyone who says so, it’s not true.   

Tedros also rebutted some of the member state comments about bias in the WHO report on the situation in Gaza – although he did not refer to the allegations about Hamas militarisation of health facilities. 

But Tedros noted that the number of Israeli deaths during the war, (about 1,539) had been cited alongside the death toll for Gaza Palestinians, reported at more than 45,000 casualties. 

And the report makes reference to the 251 hostages originally taken by Hamas, of which there were still 107 in Hamas captivity as of 31 August when the report was drafted, he said.  Following the hostage releases seen during the cease-fire, some 76 Israelis and foreigners remain in Hamas captivity, although only about 42 are still believed to be alive. 

“So I just wanted to remind the representatives that this is a balanced report,” he said.

Image Credits: @nabilajamal, WHO.