The idea that the system designed to protect and deliver quality healthcare to those displaced by conflict or persecution remains fundamentally broken is hardly new. It has become self-evident. Funding to support distressed communities has nearly evaporated, and whatever fiction of international law we once believed is no longer tenable. Yet, our attention tends to focus solely on the most recent episode of conflict and devastation, relegating previous crises, which remain equally acute, to distant corners of our memory with a do-not-disturb sign.
This may appear as a sudden series of events over the last couple of years, but impacted communities and historians will attest that this has been unfolding for a long time. Global financing for supporting the forcibly displaced has followed donor priorities rather than actual need. International law has always been applied selectively. The health of some has been advertised as critically important, while the safety and well-being of others has consistently been rendered invisible.
The Lancet Commission's Work
For the past two years, a group of public health experts, practitioners, and researchers has been grappling with this very question: how did we end up at this point, and where do we go from here? Led by colleagues at Johns Hopkins University and the Geneva Centre of Humanitarian Studies, the Lancet Commission on Health, Conflict and Forced Displacement brought together dozens of researchers, practitioners, and next-generation scholars from high, medium, and low-income countries worldwide. I was privileged to be part of this commission, which explored questions including the governance and history of the humanitarian system, the financial and political challenges we face, the disregard of local communities, gaps in coordination, the opportunities and challenges posed by new technologies, and what a better system might look like.
The team analyzed existing data, collected stories of people on the move, and consulted a variety of experts—from those working in large organizations to those on the front lines. The final report, released last month and publicly available, proposes a set of four organizing principles:
- Inverting power and shifting decision-making to local communities
- Ending impunity and enforcing accountability
- Aligning financial resources with need rather than donor priorities
- Ensuring health for all as a fundamental human right, non-negotiable
Challenges and Realities
We recognize that this is easier said than done, and that some of these guiding principles must acknowledge ground realities. For instance, what happens when local governments target individuals based on faith, gender, race, political affiliation, or other discriminating factors? How does one empower the local public sector in such cases? The answers are not easy, but the solution is neither to disengage nor to make decisions in fancy hotels in glittering cities far from the regions of need. Instead, it is to work with local physicians, researchers, practitioners, human rights advocates, and community members who are committed to delivering care, especially when it is politically challenging.
Many other scenarios and questions will test these recommendations, and I hope new and more refined ideas emerge from these conversations and disagreements. The report should serve as a floor, not a ceiling, for debate—especially at a time when so much seems to be moving in the wrong direction.
A Call for Universal Health Protection
Our work should be viewed as part of a continuum. The idea of health for all means protecting everyone: those forced to flee their homes due to falling bombs, and those permanently stuck in slums because the state does not recognize them as people; protecting victims of armed conflict; and protecting the female physician performing her duties in her office in Quetta from unspeakable acts of violence. In reality, the guiding principle to reimagine healthcare is not about others we focus on, but about all of us. It is ultimately a permanent contract to uphold our values as decent and caring human beings, everywhere and always.
