Editorial
As highlighted in today’s Lancet, protracted conflicts continue to harm human health and wellbeing. In Yemen, 21 million of 24 million people are now in need of humanitarian assistance and 15 million lack access to health care (see World Report). In Syria, despite a recent ceasefire agreement, fighting looks set to continue into its sixth year. A letter in this issue draws attention to the plight of the 1 million Syrian children who have been orphaned by the war. Worldwide, 60 million people have been forced from their homes by conflict and violence. Additionally, 218 million people are affected by disasters every year. What can be done to prevent and ameliorate this large-scale human suffering and improve our global response? The first-ever World Humanitarian Summit (May 23–24, 2016) in Istanbul, Turkey, hopes to have some answers. The Summit, convened by the UN Secretary-General Ban Ki-moon, aims to not only seek better ways to meet the needs of people affected by crises, but also to link aid with sustainable development, and work to prevent conflicts and build resilience against disasters. It is the culmination of 3 years of consultations reaching more than 23 000 people in 153 countries, and a global consultation, which took place in Geneva, Switzerland, in October, 2015. Last week, Ban Ki-moon released his report for the meeting—One Humanity: Shared Responsibility—which presents his vision for humanitarian reform. The report sets out five core responsibilities for the international community, which Ban Ki-moon states are “critical for delivering better for humanity”: political leadership to prevent and end conflicts; strengthen compliance to international law; ensure no one is left behind; move from aid delivery to ending need; and political, institutional, and financial investment into this agenda. Responsibilities three and four are the most pertinent to health. To leave no one behind is a central theme of the Sustainable Development Goals (SDGs). Under his agenda, Ban Ki-moon states that this means reaching those in situations of conflict, disasters, vulnerability, and risk first, so that they benefit from and contribute to sustainable, long-term development. He calls for a wide range of actions to achieve this goal, some of which are more concrete than others. The more tangible targets and ideas include: a comprehensive global plan to reduce www.thelancet.com Vol 387 February 20, 2016
internal displacement—in a dignified and safe manner— by at least 50% by 2030; establishment of a new international cooperation framework on predictable and equitable responsibility-sharing to respond to largescale refugee movements; and provision of adequate long-term, predictable funding to support countries that host refugees, including for health care and other vital public services. Responsibility four is a call for humanitarian and development agencies to respond in a more unified way, to move from emergency relief to longer term solutions, with the SDGs as a common overall results and accountability framework. Ban Ki-moon urges the international aid system, including the UN, nongovernmental organisations, and donors to commit to three fundamental shifts: reinforce, do not replace national and local systems; anticipate, do not wait, for crises; and transcend the humanitarian–development divide by working towards collective outcomes, based on comparative advantage and over multi-year timeframes. Some stakeholders have criticised the report for its large number of recommendations (there are more than 120) and failure to prioritise. Others have highlighted how reform of the UN system is side-stepped in the document. These are fair criticisms. We would add that more could have been specifically included on health. For example, non-communicable diseases (NCDs) in conflict-affected populations are a serious, neglected health concern. NCDs, and the substantial funds needed for their treatment, should have been acknowledged. The report could have also recognised the opportunity of using the skills and training of refugee doctors and nurses who are often not allowed to provide services in their own refugee communities. However, despite these shortcomings, one, overarching issue is clear: the current response to health and humanitarian crises has substantial failings. The deaths of 5000 migrants in 2015 who lost their lives trying to reach safety in other countries is a recent, tragic testament to the problems. Ban Ki-moon’s initiative is an ambitious attempt to address the situation. Its realisation will depend on how seriously countries believe in, value, and are willing to act on the concept of collective responsibility. The outcomes of the Istanbul Summit will be a measure of their commitment to global unity. The Lancet
Pacific Press/Corbis
An ambitious agenda for humanity
See World Report page 734 See Correspondence page 745
For more on the World Humanitarian Summit see https://www. worldhumanitariansummit.org/ For One Humanity: Shared Responsibility see https://www. worldhumanitariansummit.org/ bitcache/5861a3b8dc0a6e280cf 0da2f0fae9c6167bd0122?vid=5 69103&disposition=inline&op= view
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As highlighted in today’s Lancet, protracted conflicts continue to harm human health and wellbeing. In Yemen, 21 million of 24 million people are now in need of humanitarian assistance and 15 million lack access to health care (see World Report). In Syria, despite a recent ceasefire agreement, fighting looks set to continue into its sixth year. A letter in this issue draws attention to the plight of the 1 million Syrian children who have been orphaned by the war. Worldwide, 60 million people have been forced from their homes by conflict and violence. Additionally, 218 million people are affected by disasters every year. What can be done to prevent and ameliorate this large-scale human suffering and improve our global response? The first-ever World Humanitarian Summit (May 23–24, 2016) in Istanbul, Turkey, hopes to have some answers. The Summit, convened by the UN Secretary-General Ban Ki-moon, aims to not only seek better ways to meet the needs of people affected by crises, but also to link aid with sustainable development, and work to prevent conflicts and build resilience against disasters. It is the culmination of 3 years of consultations reaching more than 23 000 people in 153 countries, and a global consultation, which took place in Geneva, Switzerland, in October, 2015. Last week, Ban Ki-moon released his report for the meeting—One Humanity: Shared Responsibility—which presents his vision for humanitarian reform. The report sets out five core responsibilities for the international community, which Ban Ki-moon states are “critical for delivering better for humanity”: political leadership to prevent and end conflicts; strengthen compliance to international law; ensure no one is left behind; move from aid delivery to ending need; and political, institutional, and financial investment into this agenda. Responsibilities three and four are the most pertinent to health. To leave no one behind is a central theme of the Sustainable Development Goals (SDGs). Under his agenda, Ban Ki-moon states that this means reaching those in situations of conflict, disasters, vulnerability, and risk first, so that they benefit from and contribute to sustainable, long-term development. He calls for a wide range of actions to achieve this goal, some of which are more concrete than others. The more tangible targets and ideas include: a comprehensive global plan to reduce www.thelancet.com Vol 387 February 20, 2016
internal displacement—in a dignified and safe manner— by at least 50% by 2030; establishment of a new international cooperation framework on predictable and equitable responsibility-sharing to respond to largescale refugee movements; and provision of adequate long-term, predictable funding to support countries that host refugees, including for health care and other vital public services. Responsibility four is a call for humanitarian and development agencies to respond in a more unified way, to move from emergency relief to longer term solutions, with the SDGs as a common overall results and accountability framework. Ban Ki-moon urges the international aid system, including the UN, nongovernmental organisations, and donors to commit to three fundamental shifts: reinforce, do not replace national and local systems; anticipate, do not wait, for crises; and transcend the humanitarian–development divide by working towards collective outcomes, based on comparative advantage and over multi-year timeframes. Some stakeholders have criticised the report for its large number of recommendations (there are more than 120) and failure to prioritise. Others have highlighted how reform of the UN system is side-stepped in the document. These are fair criticisms. We would add that more could have been specifically included on health. For example, non-communicable diseases (NCDs) in conflict-affected populations are a serious, neglected health concern. NCDs, and the substantial funds needed for their treatment, should have been acknowledged. The report could have also recognised the opportunity of using the skills and training of refugee doctors and nurses who are often not allowed to provide services in their own refugee communities. However, despite these shortcomings, one, overarching issue is clear: the current response to health and humanitarian crises has substantial failings. The deaths of 5000 migrants in 2015 who lost their lives trying to reach safety in other countries is a recent, tragic testament to the problems. Ban Ki-moon’s initiative is an ambitious attempt to address the situation. Its realisation will depend on how seriously countries believe in, value, and are willing to act on the concept of collective responsibility. The outcomes of the Istanbul Summit will be a measure of their commitment to global unity. The Lancet
Pacific Press/Corbis
An ambitious agenda for humanity
See World Report page 734 See Correspondence page 745
For more on the World Humanitarian Summit see https://www. worldhumanitariansummit.org/ For One Humanity: Shared Responsibility see https://www. worldhumanitariansummit.org/ bitcache/5861a3b8dc0a6e280cf 0da2f0fae9c6167bd0122?vid=5 69103&disposition=inline&op= view
717
