The ouster of Bangladesh’s long-ruling Prime Minister Sheikh Hasina in a student-led revolution this week could reverberate through the World Health Organization (WHO), where her daughter holds a key regional post.

Saima Wazed, installed earlier this year as regional director for WHO’s South-East Asia (WHO-SEARO) office after a contested election, now faces increased scrutiny following her mother’s fall from power.

Wazed’s appointment was seen as driven by her mother’s political influence, according to multiple sources who spoke on the condition of anonymity. Sources in Bangladesh, speaking to Health Policy Watch, suggested Hasina had sought to secure an international position for her daughter amid growing political instability.

Wazed’s election to lead WHO’s South-East Asia office, which oversees health policies for over a billion people, raised concerns amongst health experts. Despite lacking significant global health experience or a medical degree, she was chosen over a 30-year WHO veteran from Nepal.

Sources within WHO told Health Policy Watch that her tenure has been marked by confusion and mismanagement, validating concerns raised by critics prior to her election. The sudden loss of her mother’s political power may further complicate Wazed’s position.

“I would be surprised if it’s not going to actually hamper her work,” said Mukesh Kapila, a Geneva-based physician and public health specialist. “She’ll have to work twice as hard, and there will be that much more mistrust.”

Political pressure on WHO officials from their home countries has precedent. In 2022, Bloomberg News reported on documents outlining an alleged Ethiopian government plan to discredit WHO Director-General Tedros Adhanom Ghebreyesus ahead of his re-election bid.

The reported campaign, which included accusations of corruption and sexual misconduct, coincided with escalating tensions between Ethiopia’s government and Tedros’ home region of Tigray, where he had political ties before joining WHO.

Interim government takes power

The new Bangladeshi regime, potentially hostile to Hasina, could complicate Wazed’s position at WHO. The interim government is set to be led by Muhammad Yunus, who won the Nobel Peace Prize in 2006 for his microfinance work helping lift Bangladeshis out of poverty.

Hasina’s government pursued multiple criminal charges against Yunus while in power, including corruption, tax evasion and money laundering. Human rights groups described the persistent prosecution of the Nobel laureate as “emblematic of the beleaguered state of human rights in Bangladesh, where the authorities have eroded freedoms and bulldozed critics into submission.”

“I think a lot depends on what happens with the Bangladesh government, the interim government, and then whatever government follows,” said Kapila. “If there is a vindictive element in the new government…then, undoubtedly, they could make her life in WHO difficult.”

Forced to resign under army pressure, Hasina fled to India earlier this week. Her career as a scion of modern Bangladesh’s founding dynasty spanned decades from leading a popular democratic uprising against military rule in 1990 to now, in the view of her critics, destroying the democracy she fought to create.

Wazed expressed her sadness at the political turmoil in her country while reiterating her commitment to her role at the WHO.

Hasina came to power in 2008 and for the better part of the last decade has crushed dissent, jailed political opponents, and clamped down on media using extra-judicial killings and torture.

Earlier this year her government won yet another election boycotted by the opposition.

The protests that led to Hasina’s resignation began peacefully but turned violent. Human Rights Watch reported an estimated 300 deaths, thousands of injuries, and over 10,000 arrests.

Heartbroken with the loss of life in my country 🇧🇩 that I love. So heartbroken that I cannot see and hug my mother during this difficult time. I remain committed to my role as RD @WHOSEARO @WHO #HealthForAll #OneWHO

— Saima Wazed (@drSaimaWazed) August 8, 2024

WHO’s integrity in the dock

The 2023 WHO-SEARO regional director election took place between just two candidates amid reports of bullying from Hasina’s government to force countries to withdraw their candidates to limit competition. This contrasted sharply with other regions’ elections taking place around the same time: the Western Pacific had five candidates in the fray, and the Eastern Mediterranean region had six.

Media reports emerged from in and outside Bangladesh of trade deals being struck in exchange for a vote for Wazed in the election. India, now hosting Hasina in exile, reportedly supported her candidacy.

She won as expected over WHO veteran Dr Shambhu Prasad Acharya who was nominated by his home country Nepal.

Reports of widespread anger against Indian Prime Minister Narendra Modi’s government have emerged in Bangladesh, with critics accusing Modi of supporting Hasina’s rule and helping her remain in power.

To what extent this will affect Wazed’s ability to push WHO’s agenda in the region remains unclear.

Calls for electoral reform

Health experts and advocates are pushing for a change in the election of the regional directors following controversial appointments like Wazed’s.

“One proposal is to abolish the electoral process altogether in favour of the Director-General appointing regional directors,” wrote a group of health advocates, including former New Zealand Prime Minister Helen Clarke, in a correspondence to the peer-reviewed medical journal The Lancet last year.

“This change might not obviate the political nature of the appointments but would serve One WHO aspirations,” they added.

Other suggestions included revising eligibility criteria, holding town hall meetings, and increasing interactions with journalists. The authors highlighted concerns about corruption, vote trading, and campaign finance. They called for full transparency of campaign contributions and spending.

“A more difficult set of issues concerns alleged corruption and non-adherence to codes of conduct with respect to vote trading, negative campaigning, and campaign finance. Spendings and full transparency of campaign contributions is needed,” the letter said.

They also urged WHO to prohibit member states from nominating close relatives and friends and to establish a whistleblower function during elections.

Despite these recommendations, little has changed. WHO has not publicly addressed allegations of nepotism or concerns about the election’s integrity.

“It does not mean that people in Geneva in WHO aren’t embarrassed or don’t recognize what has happened, or feel bad about it,” Kapila said. “But this is one of the problems of the governance of the organization.”

Image Credits: X/Saima Wazed, WEF.