The World Health Assembly (WHA) voted 91-2 to adopt a resolution condemning Iranian attacks on civilian infrastructure across Gulf countries amid its war with the United States and Israel.

The resolution condemns “in the strongest terms” the Iranian attacks on civilians and civilian objects in Gulf states and Jordan, citing damage to “medical and healthcare facilities, water desalination plants, energy facilities, airports and ports.”

It further calls on member states to safeguard health system continuity and address disruptions to maritime routes, “including through the Strait of Hormuz, in order to safeguard global health supply chains.”

Support for the resolution, spearheaded by the states of the Gulf Cooperation Council (GCC) and Jordan, included every country in the Middle East excluding Iran, all European Union Members, and Ukraine, which has rallied alongside Gulf states due to Iran’s role in supplying drones used by Russia to invade its skies.

“These public health consequences addressed in this resolution clearly fall within the mandate of the WHO, and it focuses exclusively on the public health consequences and humanitarian locations resulting from their terrorist Iranian attacks,” the United Arab Emirates said following the vote.

Iran was joined only by Nicaragua in opposition.

“These attacks also have health implications at the global level,” the UAE added. “As we’ve seen from Iran’s disruption of the Strait of Hormuz, and to the essential lifelines for the delivery of medicines, vaccines, medical products, essential health commodities, food, and fuel, all of which are necessary for the functioning of health systems.”

The Iranian delegation described the resolution as applying “a selective use of international law”, which it called “inconsistent with the technical, evidence-based and impartial character of the organisation” and setting “a dangerous precedent that risks eroding the main objective and functions” of the WHO.

“The proposed text deliberately ignores severe damages inflicted on Iran’s own health infrastructure as a result of military actions in the region,” its delegate said. “It fails to acknowledge the root causes of the current situation, including provocations and aggressions that compel defensive responses while presenting a distorted and incomplete picture of events.”

The resolution asks WHO Director-General Dr Tedros Adhanom Ghebreyesus to deliver two reports to next year’s WHA: a global assessment of how Hormuz disruptions and rising energy and transport costs are affecting access to medicines, vaccines and essential health commodities in low- and middle-income countries, and a separate report on the mental health toll of the Iranian attacks and on supply-chain delays for humanitarian medical deliveries.

“We are deeply concerned by the suffering of civilians and the destruction of health systems, civilian infrastructure, and supply chains,” Indonesia’s delegation said.

“The destruction is profound, but it has not fallen equally across the region. A credible public health response is possible only when all parties see hostilities and return to the path of diplomacy.”

Notable abstentions

Thirty-one countries abstained, including Switzerland, Mexico, Russia, South Africa, Brazil, China, Indonesia and Malaysia.

China described the Iranian crisis as “one of the most urgent challenges” faced by the international community – and became the only country in the assembly to address the US-sized elephant in the room.

“The root cause of this crisis is that an individual country, without the Security Council’s authorisation, has flagrantly launched a military attack on Iran, which seriously violates the basic norms governing international relations based on the principles of the UN charter,” China said.

“WHO’s response should follow the principles of objectivity, neutrality, and professionalism, which will help de-escalate the situation rather than aggravating tensions.”

South Africa, acknowledging the severe threat of rising energy, fertilizer and seed costs on the livelihoods of people on the African continent in particular, struck a similar middle-ground, noting that while there can be “no military solution” to the war, its “root causes cannot be ignored.”

“We have spoken out against attacks on all sides of the conflict. The ravages of the conflict across the region must be acknowledged, as we cannot afford to create a hierarchy of victims,” said South Africa.

Strait of Hormuz supply shocks

The resolution takes particular aim at the continued de facto closure of the Strait of Hormuz, which has seriously disrupted supply chains for life-saving medicines, food, fertiliser, fuel and commodities on which health systems and the livelihoods of civilian populations depend.

“The continued closure of the Strait of Hormuz remains a critical pressure point, disrupting global supply chains and increasing the cost of essential medical commodities,” said WHO Assistant Director-General Dr Chikwe Ihekweazu. “Humanitarian settings are already experiencing funding shortages, now further compounded by fuel, food, and medicine costs.”

Several countries in the midst of intense conflicts worsened by the closure of the Strait, including Sudan, Somalia and Yemen, joined the resolution as co-authors. None of the three currently holds voting powers at the WHO due to unpaid membership dues.

“The de facto closure of the Strait of Hormuz has only compounded the impacts on already devastated healthcare systems in some of the most vulnerable humanitarian contexts in the world, from Sudan to Gaza,” the UK delegation said. “The delayed supply of medicines and vaccines, and the increasing fuel costs, are reducing the reliability of essential services.”

Both the US and Iran blame the closure on one another. Iran has turned the Strait into a minefield and begun enforcing a tiered system of checkpoints and fees, and the US military continues to enforce a blockade on vessels bound for Iran.

Countries on both sides of the resolution vote reaffirmed the importance of opening the Strait.

Healthcare is a war target now

The resolution’s focus on the security of medical personnel and facilities reflects growing concern about the dark tide of violence against health workers and facilities that has come to define modern conflicts.

“It cannot be emphasised enough that civilian healthcare personnel, hospitals, and medical facilities must be respected and protected at all times in accordance with international humanitarian law,” Malaysia’s delegate said.

Attacks on hospitals, once cause for severe international reckoning and condemnation, are now routine in wars around the globe. Healthcare – in modern war – is now a target.

Russian strikes on Ukrainian healthcare since the start of its full-scale invasion surpassed the 3,000 mark earlier this month.

In Gaza, the has confirmed 2,148 attacks on healthcare since the war began, resulting in 1,048 deaths – destruction so complete UN Special Rapporteurs call it a “medicide”.

Amid Sudan’s brutal civil war, the violence inflicted on medical facilities and personnel – particularly in the throws the ongoing genocide in Darfur – is equally extreme, with WHO confirming at least 2,052 deaths.

No healthcare strikes

While Iran has launched hundreds of missile and drone strikes throughout the region – hitting residential buildings, desalination plants, energy infrastructure, hotels, airports, embassies and other civilian targets, resulting in 41 deaths, no direct attacks on healthcare have been documented in the WHO’s Surveillance System for Attacks on Healthcare (SSA) database.

Independent global authorities, including conflict monitor ACLED and Human Rights Watch, equally list no attacks on healthcare by Iran’s strikes out of 660 listed. However, Israeli health facilities have been struck hit times by Iranian attacks.

However, Iranian strikes have repeatedly hit desalination plants, the foundation of clean water systems in the Gulf. Another attack set a fire outside the UAE’s largest nuclear power plant, raising fears it could be targeted again.

“Several Gulf countries rely on desalination for 70 to 90% of safe water supplies, making these systems both essential and highly vulnerable,” said Dr Hanan Balky, WHO’s Eastern Mediterranean regional director.

“Damage to energy and desalination infrastructure carry major public health risks, including worsening air pollution, worsening air pollution, disruption to safe water supply and sanitation, and reduced continuity of essential health services.”

Resolution from Iran defeated

On Tuesday, Lebanon received overwhelming support from the majority of member states in the wake of Israeli attacks on its health infrastructure.

Ninety-five member states voted in favour of a resolution that noted “a health emergency in Lebanon resulting from ongoing and recently intensified hostilities” and called for “the full protection of healthcare in Lebanon, including patients, health personnel, facilities and transport”.

Only Israel and Honduras opposed the resolution, which did not name Israel as the aggressor.

SSA documents 170 attacks on health infrastructure in Lebanon, resulting in 116 deaths of medical personnel and patients. Israeli strikes so far have killed around 2,700 people.

“Millions of people have been displaced, approximately 3.2 million internally displaced people in the Islamic Republic, and one million in Lebanon,” Ihekweazu said, citing IOM figures.

Meanwhile, the SSA has confirmed 32 attacks on Iranian health facilities since the onset of the violence, resulting in 12 deaths. The US and Israel have launched thousands of bombs across the country, killing a total of at least 3,375 people.

However, during the same debate on Tuesday, Iran’s resolution, condemning recent attacks on its patients and health infrastructure, including on the Pasteur Institute, was defeated.

Only 19 countries supported Iran, 30 voted against, and a whopping 58 countries abstained. Several countries cited Iran’s attacks against its own citizens and Gulf states, and the blockade of the Strait of Hormuz, preventing the flow of medical supplies, as reasons for not supporting the resolution.

Image Credits: X/WHO.