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Health and foreign policy in question: the case of  humanitarian action
Health and foreign policy in question: the case of  humanitarian action
Health and foreign policy in question: the case of  humanitarian action
Health and foreign policy in question: the case of  humanitarian action
Health and foreign policy in question: the case of  humanitarian action
Health and foreign policy in question: the case of  humanitarian action
Health and foreign policy in question: the case of  humanitarian action
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Health and foreign policy in question: the case of humanitarian action

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Health has gained recognition as a foreign policy concern in recent years. Political leaders increasingly address global health problems within their international relations agendas. The confluence of …

Health has gained recognition as a foreign policy concern in recent years. Political leaders increasingly address global health problems within their international relations agendas. The confluence of health and foreign policy has opened these issues to analysis that helps clarify the tenets and determinants of this linkage, offering a new framework for international health policy. Yet as health remains profoundly bound to altruistic values, caution is required before generalizing about the positive outcomes of merging international health and foreign policy principles. In particular, the possible side-effects of this framework deserve further consideration. This paper examines the interaction of health and foreign policy in humanitarian action, where public health and foreign policy are often in direct conflict. Using a case-based approach, this analysis shows that health and foreign policy need not be at odds in this context, although there are situations where altruistic and interest-based values compete. The hierarchy of foreign policy functions must be challenged to avoid misuse of national authority where health interventions do not coincide with national security and domestic interests

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  • 1. Health and foreign policy in question: the case ofhumanitarian actionMichel Thieren a Abstract Health has gained recognition as a foreign policy concern in recent years. Political leaders increasingly address global health problems within their international relations agendas. The confluence of health and foreign policy has opened these issues to analysis that helps clarify the tenets and determinants of this linkage, offering a new framework for international health policy. Yet as health remains profoundly bound to altruistic values, caution is required before generalizing about the positive outcomes of merging international health and foreign policy principles. In particular, the possible side-effects of this framework deserve further consideration. This paper examines the interaction of health and foreign policy in humanitarian action, where public health and foreign policy are often in direct conflict. Using a case-based approach, this analysis shows that health and foreign policy need not be at odds in this context, although there are situations where altruistic and interest-based values compete. The hierarchy of foreign policy functions must be challenged to avoid misuse of national authority where health interventions do not coincide with national security and domestic interests. Bulletin of the World Health Organization 2007;85:218-224.Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español. .‫الرتجمة العربية لهذه الخالصة يف نهاية النص الكامل لهذه املقالة‬Introduction economic and national security, and dis- attempted, any generalization of the cusses how each relates to health. Specifi- health and foreign policy concept thatThe linkages between health and the cally, he proposes various interpretations does not adopt an altruistically inspiredglobal policy agenda are well estab- of the emergency of health concerns framework is bound to either translatelished.1–5 Examples include global efforts along that spectrum of functions from into wishful statements or lead to anto control communicable diseases such “hard power” to “soft power”.6 A mutu- unequal weighting of health issues ac-as avian flu, human immunodeficiency ally stimulating relationship — which at cording to the predominant hierarchy ofvirus/ acquired immunodeficiency syn- times is misconstrued as mutually benefi- foreign policy functions. Re-conceptual-drome (HIV/AIDS) and poliomyelitis; cial — between health and foreign policy izing health and foreign policy mitigatesthe pre-eminence of health among the has been widely observed. However, the these risks.Millennium Development Goals; health concept of health’s emergence in foreign After outlining concepts and defini-trade and financing issues; and interna- policy circles is difficult to reconcile with tions and setting the scope and functionstional law’s growing recognition of these empirical cases that reveal deep silences of humanitarian action, this paper willconcerns through endorsement of the with respect to important components use examples to analyse how health andInternational Health Regulations. All of of international health principles.7 Dif- foreign policy can support such action.these cases reflect the increasing focuses of ferent approaches and cases are needed It will be clear that these differentiallyrelationship, discussion and negotiation to test the validity and strength of health powered interactions point to an an-of health matters between countries. and foreign policy linkages before gen- tagonistic relationship between health In recent years, normative work has eralizing about a mutually beneficial and foreign policy in the context of hu-decrypted this multifaceted relationship merger. The specific case of how health manitarian crises. This antagonism callsbetween health and foreign policies. and humanitarian action cooperate with for caution in applying the health andPannisset conceptualizes the relation- foreign policies promoting a peace settle- foreign policy nexus beyond the realmship between international health and ment provides good conditions for such of national interest.international relations on the premise a test.that both “result from dynamic social, This paper uses a case-based Socraticcultural, economic and political inter- argument to demonstrate that no mat- Concepts and definitionsactions among different populations”.1 ter how health is disguised in political Social sciences teach that humanitarianFidler 2,3 builds on the hierarchical order terms, it will never uproot itself from (altruistic) and political (interest-based)of foreign policy functions ranging from its fundamentally altruistic, people- actions stem from a common root — anhuman dignity and development to centred identity. And while this is often act of giving — but have evolved ina Measurement and Health Information Systems, World Health Organization, 20 ave Appia, 1211 Geneva 27, Switzerland. Correspondence to Michel Thieren (email: thierenm@who.int).Ref. No. 06-038273(Submitted: 31 October 2006 – Final revised version received: 22 December 2006 – Accepted: 17 January 2007 )218 Bulletin of the World Health Organization | March 2007, 85 (3)
  • 2. Special theme — Health and foreign policyMichel Thieren Humanitarian action, health and foreign policyopposite directions. Sociologist Marcel these altruistic values so they are not Code of Conduct for the InternationalMauss (1925)8 in France and anthro- overlooked by those who argue “every- Red Cross and Red Crescent Movementpologist Bronislaw Malinowski (1922)9 thing is political”. and Nongovernmental Organizations inin the United Kingdom established that Disaster Relief 12 and the SPHERE Proj-in archaic societies an act of giving was a Functions and principles of ect’s Humanitarian Charter 13 best sum-means to build ties between two groups marize the guiding principles of humani-of people: a donor group and a recipient humanitarian action tarian action. Inspired by internationalgroup. The former gives, the latter re- Humanitarian action is complex and human rights and humanitarian law,turns the gift, so both receive. The act of multidimensional (Fig. 1). It conducts these texts establish the pre-eminence ofgiving in these societies is a mechanism programmatic activities such as protect- a humanitarian imperative that couplesof permanent exchange of goods neces- ing civilians affected by disasters, repa- “the right to receive humanitarian assis-sary for a group to govern relationships triating refugees, exchanging prisoners tance and to offer it for and by all citizenswith another group, and thus a way for of war, demobilizing combatants and of all countries” with the obligation toarchaic societies to maintain control over providing vital assistance such as food, provide aid and protection wherevereach other. In this respect, it can be seen water, sanitation, shelter, health services and whenever needed. These documentsas a remote ancestor of foreign policy, a and advocacy for people subject to all insist on the non-partisan and altruisticway to solicit mutual interests between sorts of distress, including political, nature of humanitarian action, whichtwo groups of people or societies. physical, sexual, psychological and eco- must remain strictly need-based and In today’s world, acts of giving such nomic harms. reflect the principles of impartiality, neu-as humanitarian action are no longer Assistance, protection of rights and trality and independence. Humanitariannecessary to establish the structures and advocacy are core humanitarian func- response “shall endeavour not to act associal fabric of societies. Rather, these tions. Their objectives are to save lives, an instrument of foreign governmentacts of giving are confined to the very alleviate suffering and maintain human policy” and is accountable to both thoserestricted but no less critical realm of dignity, hence creating the basic condi- who seek to assist and those who acceptthe moral imperative to do good.10 A tions for peace. These functions rely on resources. These instruments, developedhierarchical set of roles and responsibili- the collection and analysis of data, mak- to guide nongovernmental humanitar-ties — beyond the simple exchange of ing information-gathering a humanitar- ian action, are also useful benchmarksgoods across territories — is required to ian function as well. These functions for bilateral and multilateral aid. Whilegovern relationships between countries. feed diplomatic efforts to reach peace nongovernmental action operates withIn other words, the act of giving, trans- settlements. Humanitarian diplomacy is fewer political concerns, governmentalposed to modern times and exempli- thus a natural extension of humanitar- aid often needs to refer to these prin-fied by humanitarian action, has long ian action, but it does not confer upon ciples to counter political obstacles.escaped from the foreign policy arena. these humanitarian actors the legitimate Governmental and intergovernmentalThe altruistic, people-centred value of authority to bring about peace. At most, humanitarian assistance remains largelyhumanitarian action is in intrinsic oppo- they can play a significant role in trigger- subject to considerations of nationalsition to foreign policy’s interest-based, ing dialogue among conflicting parties.11 interest, such as public opinion pressurescountry-centric values. Ultimately, the success of a peace process and budgetary constraints.14 This social concept requires somenuance, as the opposition does not depends on political commitment rather The precedence of the humanitar-imply that foreign policy cannot be hu- than humanitarian efficacy. ian altruistic imperative over self-servingmanitarian or vice versa. Humanitarian Moral imperatives and principles politics keeps humanitarian actionarguments often guide foreign policy encapsulate humanitarian functions. The within the framework of soft-power for-decisions, but they are often regardedas a means to enhance reciprocity andnational image. Humanitarian justifica- Fig. 1. Humanitarian action and embedded principlestions are no longer altruistic then, butbecome interest-based and political. Foreign policies are domestically Aid/assistance Advocacydefined and are implemented by thecountry. They abide by national interest Informationin the sense of its pre-eminence over —and not exclusion from — the interestsof the population. Conversely, humani- Protection (human rights,tarian values are universally defined and demobilization,agreed upon, and reflect broader interests repatriation)than those of any country or populationgroup. These values leave little room forcompromise when they compete withdomestic or national interests. This Humanitarian principles:does not mean that altruistic values do Independence – impartiality –not have political consequences. The neutrality – dignity – accountabilityintention here is to unveil and highlightBulletin of the World Health Organization | March 2007, 85 (3) 219
  • 3. Special theme — Health and foreign policy Humanitarian action, health and foreign policy Michel Thieren Fig. 2. Humanitarian and foreign policy functions Foreign policy functionsa National security High politics Hard power Economic interest Humanitarian action functions (Fig.1) Aid/assistance Advocacy Development Information Protection Human dignity Low politics (human rights, demobilization, Soft power repatriation) Humanitarian principles: Independence – impartiality – neutrality – dignity – accountability a Adapted from Fidler.2eign policy (Fig. 2). The past 15 years mirrors the ethno-political divisions ity the way it was proposed on paper.have seen efforts to develop a coherent they embodied at the war’s end.18 The To make “coherence” work, the makersagenda uniting humanitarian and politi- case of the former Yugoslavia (similar of foreign policy had to reaffirm theircal actions. to the contemporary cases of Somalia commitment to the basic humanitar- and Africa’s Great Lakes) confirmed how ian principles of impartiality, neutralityA marriage of convenience politics and humanitarian action can be and independence, and to comply with mutually damaging when the latter is the 23 Principles and Good Practices ofMédecins sans Frontières told the Nobel taken as a substitute for the former. Humanitarian Donorship.20,21 In foreignCommittee “Humanitarian action is an These failures signalled the need policy terms, this meant compromisesact of indignation, a refusal to accept an to rethink ways for humanitarian and with national interests. Instead, especiallyactive or passive assault on the other.” 15 political action to work together. A “new in non-strategic areas, donor govern-This echoes social theory highlighting humanitarianism” became the modus ments gradually disengaged from po-the altruistic nature of humanitarian operandi of a “policy of coherence” aim- litical duties, leaving their humanitarianaction as a true act of giving. Yet in ing to reinvigorate humanitarian action branches with impossible conflict man-practice, both unofficial and govern- at government and international levels.19 agement agendas. The “policy of coher-ment actors recognize that humanitarian This effort sought commonalities be- ence” implemented in Afghanistan andaction, mixed as it is with politics, does tween humanitarian action and military, Sudan, although based on analyses ofhave political consequences. peace-building and nation-building the early 1990s’ humanitarian tragedies, During the conflict in the former interventions. To accommodate this reconfirmed the difficulties involved inYugoslavia, most European countries approach, institutions have changed associating humanitarian and politicalformulated their Balkan policies in hu- both at national and international levels. actions.manitarian terms, such as the need to es- Special offices for foreign disaster man-tablish protected humanitarian corridors agement were established within foreign Health and foreign policy handand safety zones. These measures could affairs ministries, with mandates similar in hand?in the short term allow massive numbers to that of the United Nations Office Health is a prominent consideration inof people to escape violence. In the long for the Coordination of Humanitarian humanitarian action but has varyingrun, the consequences were tragic on Affairs.19 At both levels, the intention importance across humanitarian func-both political and humanitarian sides: was to harmonize humanitarian re- tions. Although central in humanitarianhumanitarian evacuation fed mass sponses to conflict with political and aid and broadly used as a benchmarkdeportation and consequently “ethnic peace-building operations. for good humanitarian practice overall,cleansing”,16 and safety zones fuelled the The “new humanitarianism” sought health plays a lesser role in humanitarianillusion of protection which in the case of to link humanitarian and political action areas that are more closely linked withSrebrenica led to massacre.17 More than under the umbrella of foreign policy, but foreign policy (protection, demobiliza-a decade later, Bosnia and Herzegovina predictably it did not work out in real- tion, repatriation, humanitarian diplo-220 Bulletin of the World Health Organization | March 2007, 85 (3)
  • 4. Special theme — Health and foreign policyMichel Thieren Humanitarian action, health and foreign policymacy). In fact, health tends to score Fig. 3. Respective contribution and weighta of health and foreign policy on corehighly in humanitarian practice where humanitarian functionsforeign policy cannot and vice versa, asFig. 3 and the following examples mayclarify.Humanitarian aid AidHealth and its associated disciplines ofnutrition, water and sanitation are the Informationgist of humanitarian aid because theyrespond to vital human needs. These sec-tors are the most frequently budgeted aid Advocacy Foreign Healthactivities implemented in the aftermath policyof and recovery from disasters.22 Protection When delivered in the name of (or (human rights,as an alternative to) political efforts, aid demobilization, repatriation)can be harmful. In 1994, in the formerDemocratic Republic of the Congo, agovernment agency made large quan-tities of ciprofloxacin, an expensivesecond-line treatment for dysentery,available to Rwandan refugees. The useof that powerful antibiotic encouragedgerm resistance to nalidixic acid, the only a The width of the arrows indicates the strength of the relationship.affordable therapy for dysentery, alongthe Rwandan border. Infected patients its obligation to intervene more actively. 15 000 demobilized combatants of thethus became dependent on drugs they Conversely, when a group of physicians Farabundo Marti National Liberationcould not afford. Such imposed assis- established a population-based estimate Front into El Salvador’s national healthtance often offers inappropriate results of excess mortality associated with the system. The operation was a success:with regard to needs, and is for this conflict in Iraq 28 that was more than 10 each former combatant was medicallyreason termed the “second disaster.” times higher than estimates from other screened, all were given treatment when sources, the United States Government necessary, and re-entered civil society inPerformance monitoring and simply dismissed the survey figure. good health.advocacy Fortunately, the accumulation of quan- The previous year in Haiti, the sameHealth statistics inform crisis manage- titative health evidence generated by organization launched a system of drugment, attest to humanitarian perfor- humanitarian actors often generates a supply and distribution (the PROMESSmance and feed advocacy. Both political public outcry, forcing political leaders System) across a country ruled by a mili-and technical messages are sent by death to re-examine their strategies. tary junta and subject to a commercialtolls or rates; by numbers of missing, Statistics associated with health and embargo. The system distributed es-displaced and injured; and by statistics mortality indicators are politically sensi- sential medicines through a network ofshowing relative access to health ser- tive. It is imperative that humanitarian pharmacies during the period of unrest,vices, food and safe water. Despite the actors exercise technical leadership to and subsequently developed a nationaldifficulties of collecting data in disaster enforce statistical coherence, and conse- programme of essential medicines.30areas, the emerging practice of conflict quently reduce the negative effects of a In contrast, the role of physicians inepidemiology offers effective measure- political debate more focused on num- human rights’ observation and monitor-ment methods that can generate reliable bers than solutions. ing have been less successful. From 1993numbers to guide strategic decisions and to 1995, the dramatically increasinginfluence political leaders.23 Protection, demobilization and prevalence of physically abused Haitian In 2004, Physicians for Human repatriation civilians played an important role in theRights, a nongovernmental organization Medical doctors, nurses and public decision of the International Civil Mis-based in the United States, conducted health professionals often operate in the sion in Haiti to recruit civilian observershealth and examination interviews vicinity of politics, particularly when with medical training. Doctors wereamong Sudanese refugees from Darfur they contribute to solving problems in asked to research and report physicalin Chad. These experts established the areas of protection, demobilization, abuses, but not to treat the affected in-patterns of events tantamount to war promotion of human rights principles dividuals. In the long term, the presencecrimes,24 and the interviews marked and repatriation.29 However, health pro- of medical staff as observers was techni-the first time epidemiology was used to fessionals have had varying degrees of cally ambivalent, as their professional“diagnose genocide”.25 A government- success in these roles. commitments based on the Hippocraticled investigation 26 followed and led the In 1993, the United Nations gave Oath often led to therapeutic interven-United States to change its foreign policy the Pan American Health Organiza- tions beyond the scope of human rightsin the region.27 By terming the conflict tion (a World Health Organization observation.31 The healers’ presence ingenocide, the United States proclaimed regional office), the task of reintegrating this capacity jeopardized the mission’sBulletin of the World Health Organization | March 2007, 85 (3) 221
  • 5. Special theme — Health and foreign policy Humanitarian action, health and foreign policy Michel Thierenpolitical agenda. The collision of humani- north-east Bosnian civil authorities to tested in humanitarian contexts, andtarian and political actions within the oppose NATO (North Atlantic Treaty therefore prevents its generalization tomission severely weakened its capacity Organization) military peacekeeping situations where altruistic and interest-to carry out its mandate. intervention. based values are opposed. This nexus Tensions between health needs Foreign policy is a function of na- could risk the ascendancy of prioritiesand political obligations appear also in tional interests that often compete with favouring national interests, resultingrefugee repatriation. The repatriation of humanitarian principles. Consequently, in a reversal of international health360 000 Cambodian refugees in 1993 as these examples illustrate, humanitar- concerns from people-centred values towas hampered by multidrug-resistant ian action through health can operate a narrower understanding of health as amalaria endemic in predominantly agonistically with foreign policy when national security issue. Such a risk wasKhmer Rouge-controlled areas, as this officials reaffirm universal standards of acknowledged in general terms in themade repatriation of refugees medically human dignity. This requires them to 2003 report of the Commission on Hu-unwise. But this public health argu- derogate from their “hard power” obliga- man Security.35ment did not outweigh the political tions and compromise on national inter- The unequal consideration of publicimperative set forth in Cambodia’s Paris ests. Yet compliance with international health concerns in foreign policy agendaspeace accord. It was the health sector’s criminal and human rights laws is also shows that proponents of the health andresponsibility to take necessary measures a matter of national interest in so far as foreign policy nexus are only partiallyfor safe refugee repatriation. the country seeks to project a positive right. Between health and foreign policy, image worldwide. it is unclear which one has the upperDiplomacy, health and peace hand: health concerns may emerge moreThe Health as a Bridge for Peace (HBP) Conclusions substantially in hard-power politics, butproject, formally endorsed by the 51st In the context of humanitarian action, this rise does not necessarily suggestWorld Health Assembly in May 1998, health and foreign policy are at odds both that health issues have the capacity toseeks “the integration of peace-building by definition and by the responsibilities profoundly reconfigure the hierarchyconcerns, concepts, principles, strate- of the actors involved: when people are of these functions and provide a bridgegies and practices into health relief and trapped in a conflict, maintaining their between soft and hard power. In fact, ithealth sector development”.32 This mul- health is a moral imperative for who- would be premature if not naive to as-tidimensional framework claims to aid ever wants to help. This is a matter of sume that the emergence of health withinpeace efforts by enabling communica- altruism, a priority that should not be a foreign policy framework could altertion between warring parties on matters negotiated based on national interests. its hierarchy. The hierarchy of interestsnot related to their conflict. The project Conversely, establishing and maintain- within foreign policy will remain un-aims to create a technical space in which ing a peace settlement between warring less the framework itself is challenged.opposing groups can agree on such is- parties is a matter of interest-based ne- Health issues are forced to conform tosues as health-care norms and guidelines, gotiations. The responsible actors differ the existing hierarchy of foreign policyepidemiological information exchanges in these two cases. The international functions until policy-makers are will-and health system reform strategies. health community (governmental and ing to pay the costs that change would However as it has been implemented nongovernmental) must find ways to entail.in Angola, Bosnia, eastern Slavonia dialogue constructively with foreign The concept of human security(Croatia) and Haiti, the project has never policy officials. They must advocate that offers a middle path or “third way” toyielded a tangible peace dividend.33 At altruistic values be incorporated to the mitigate the polarization of foreign pol-most, health professionals were able to greatest possible extent into the functions icy and humanitarian/health concerns.create structures, systems of behaviour, of foreign policy, and that humanitarian This middle path would require nationalinstitutions and collective actions that concerns rank high in the hierarchy of governments to “reconfigure foreignwere amenable to a culture of peace, once these functions.7 The examples given here policy around human security ratherpolitical arrangements and agreements have shown that health and humanitar- than national security, around health andwere otherwise secured. Because conflict ian actors cannot lead this dialogue well-being in addition to the protectionis inimical to health, health cannot be a in the absence of committed foreign of territorial boundaries and economicreliable bridge to peace, even if numer- policy officials. At most, public health stability”.36 This implies a widespreadous short “humanitarian ceasefires” have professionals have demonstrated a capac- recognition of global interdependenciesallowed immunization campaigns.34 In ity to initiate and contribute to critical between health and political affairs, andsome occasions, health concerns have problem-solving debates by promoting specifically a recognition that healtheven adversely affected peace implemen- normative values and evidence. However, indeed is a precondition for humantation when health-related stigmas were they have not succeeded in creating a development and political participation,used to polarize views. In early 1996, for neutral space for political settlements rather than their outcome. Oexample, soon after the signing of the through health efforts.Dayton Agreement, ostensible concerns This analysis shows the fragility of Competing interests: None declared.relating to HIV/AIDS were used by the health and foreign policy nexus when222 Bulletin of the World Health Organization | March 2007, 85 (3)
  • 6. Special theme — Health and foreign policyMichel Thieren Humanitarian action, health and foreign policyRésuméLa santé et la politique étrangère en question : le cas de l’action humanitaireCes dernières années, la santé en est venue à occuper une secondaires éventuels d’un tel cadre mérite une étude plusplace plus importante en matière de politique étrangère et les approfondie.responsables des relations extérieures sont appelés de plus en L’article examine l’interaction entre politique sanitaire etplus à aborder des problèmes de santé mondiale dans le cadre de politique étrangère dans l’action humanitaire, où il y a souventleurs activités. Du fait de la confluence de la politique étrangère conflit direct entre les impératifs de santé publique et de politiqueet de la politique de santé, ces problèmes ont donné lieu à des étrangère. Avec une méthode fondée sur des cas pratiques,analyses qui contribuent à préciser les principes et les déterminants l’analyse montre que l’opposition n’est pas inévitable, même s’ilde cette corrélation, offrant ainsi un nouveau cadre à la politique arrive parfois que des intérêts concrets ne puissent s’accommodersanitaire internationale. La santé restant intimement liée à des de certaines valeurs altruistes. Il faut remettre en cause la hiérarchievaleurs altruistes, il faut toutefois se montrer prudent et éviter des fonctions de politique étrangère pour éviter l’abus d’autoritéles généralisations abusives quant aux effets positifs d’une au niveau national lorsque des interventions sanitaires ne cadrentfusion des principes régissant la politique sanitaire internationale pas avec la sécurité et les intérêts nationaux.et la politique étrangère. En particulier, la question des effetsResumenLa salud y la política exterior en cuestión: el caso de la acción humanitariaEn los últimos años se ha registrado un creciente reconocimiento En el presente artículo se examina la interacción de la saludde la salud como una importante faceta de la política exterior. y la política exterior en la acción humanitaria, donde la saludLos líderes políticos abordan cada vez más problemas sanitarios pública y la política exterior entran a menudo en conflicto directo.mundiales en sus agendas de relaciones internacionales. La Utilizando un enfoque basado en casos, el análisis realizadoconfluencia de la salud y la política exterior ha hecho que esas muestra que la salud y la política exterior no tienen por qué estarcuestiones se sometieran a análisis que ayudan a aclarar los reñidas en esas circunstancias, aunque hay situaciones en queprincipios y los factores determinantes de ese nexo, brindando un los valores altruistas y los basados en intereses compiten entre sí.nuevo marco para la política sanitaria internacional. Sin embargo, Es necesario cuestionar la jerarquía de las funciones de políticapuesto que la salud sigue profundamente vinculada a valores exterior para evitar que se haga un uso indebido de la autoridadaltruistas, se impone la prudencia antes de generalizar acerca nacional cuando las intervenciones de salud no coincidan con losde los resultados positivos de la fusión de la salud internacional intereses y la seguridad nacionales.y los principios de política exterior. En particular, los posiblesefectos colaterales de este marco merecen ser considerados conmás detenimiento. ‫ملخص‬ ‫االصحة والسياسة الخارجية يف موضع السؤال: حالة األعامل اإلنسانية‬‫وللسياسة الخارجية مع األعامل اإلنسانية، حيث تتعارض الصحة العمومية‬ ‫اكتسبت الصحة االعرتاف بها كأحد قضايا السياسة الخارجية يف السنوات‬‫مع السياسة الخارجية بشكل مبارش يف غالب األحيان، وقد استخدمنا يف‬ ‫األخرية، ويعالج القادة السياسيون املشكالت الصحية العاملية ضمن جداول‬‫الدراسة أسلوباً يستند عىل الحاالت، وأوضحت الدراسة أن الصحة والسياسة‬ ‫األعامل الخاصة بالعالقات الدولية، وقد فتح الرتابط بني الصحة والسياسة‬‫الخارجية قد ال يتعارضان يف هذا السياق، رغم وجود حاالت تتنافس فيها‬ ‫الخارجية باب هذه املشكالت عىل مرصاعيه للتحليل، مام ساعد يف توضيح‬‫القيم املستندة عىل املنافع مع تلك التي تستند عىل اإليثار. إن البنية الهرمية‬ ‫التحدِّيات واملحتِّامت لهذه الروابط، ومقدماً بذلك إطاراً جديداً للسياسة‬‫لوظائف السياسة الخارجية يجب أن تجابه بتحدِّيات لتجنب سوء استخدام‬ ‫الصحية الدولية. ورغم أن الصحة التزال حتى يومنا هذا عميقة االرتباط‬‫السلطات الوطنية، وذلك يف املواقع التي ال تتوافق فيها التدخالت الصحية مع‬ ‫بقيم اإليثار، فالبد من الحذر قبل تعميم النتائج اإليجابية إلدماج الصحة‬ .‫األمن الوطني واملنافع الوطنية‬ ‫الدولية ومبادئ السياسة الدولية، وتستحق التأثريات الجانبية لهذا اإلطار‬ ‫بشكل خاص املزيد من االهتامم. وتدرس هذه الورقة التفاعل املتبادل للصحة‬References 1. Panisset UB. An introduction to international health statecraft. In: 4. Owen JW, Roberts O. Globalization, health and foreign policy: emerging International health statecraft: Foreign policy and public health in Peru’s linkages and interests. Global Health 2005;1(12). Available from: http:// cholera epidemic. Lanham (MD): University Press of America; 2000. www.globalizationandhealth.com/contenet/1/1/12. 2. Fidler PD. Health and foreign policy: A conceptual overview. London: Nuffield 5. Nye JS Jr. One world: Health turns into a security priority. International Herald Trust; 2005. Available from: http://www.nuffieldtrust.org.uk/ecomm/files/ Tribune, 2 September 2002. 040205Fidler.pdf 6. Nye J. Hard and Soft Power. In: Power in the global information age. Oxford: 3. Fidler DP, Drager N. Health and Foreign Policy. Bull World Health Organ Routlege; 2004. 2006;84:687.Bulletin of the World Health Organization | March 2007, 85 (3) 223
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Paris: Flammarion, 351:735-8. collection Champs; 2002. 26. Documenting atrocities in Darfur. US Department of State: Washington, DC;11. Kray K. The “New Humanitarianism”: The Henry Dunant Centre and the 2004. State Publication 11182. Available from http://www.state.gov/g/drl/ Aceh peace negotiations. Princeton: Woodrow Wilson School of Public and rls/36028.htm International Affairs 2004 Case Study 02/03. Available from: http://www. 27. Powell C. The crisis in Darfur: testimony before the Senate Foreign Relations wws.princeton.edu/cases/papers/newhumanit.html Committee. Washington, DC: US Department of State; 2004. Available from: 12. The code of conduct for the International Red Cross and Red Crescent http://www.state.gov/secretary/former/powell/remarks/36042.htm Movement and NGOs in disaster relief. Geneva: International Committee 28. Burnham G, Lafta R, Doocy S, Roberts L. Mortality after the 2003 invasion of of the Red Cross; 1995. Available from: http://www.icrc.org/Web/Eng/ Iraq: a cross-sectional cluster sample survey. Lancet 2006;368:1421-8. siteeng0.nsf/htm/57JMNB 29. Geiger HJ, Cook-Degan RM. The role of physicians in conflicts and 13. Humanitarian charter and minimum standards in disaster response. Geneva: humanitarian crises. JAMA 1993;270:616-20. SPHERE Project; 2004. 30. Tardif F. PROMESS: Une réponse structurante à des besoins fonctionnels14. Evans R. The humanitarian challenge: A foreign policy perspective. African [PROMESS: A structuring response to functional needs]. In: Regard sur Security Review, 1997:6(2). Available from: http://www.iss.co.za/pubs/ASR/ l’humanitaire. Une analyse de l’expérience haïtienne dans le secteur santé 6No2/Evans.html entre 1991 et 1994 [Critical view on humanitarian action: an analysis of 15. Médecins Sans Frontières. Nobel Lecture. Oslo: Norwegian Nobel Committee; the Haitian experience in the health sector between 1991 and 1994]. Paris: 1999. Available from: http://www.nobelprize.org/nobel_prize/peace/ Editions de l’Harmattan; 1997. laureates/1999/msf-lecture.html 31. United Nations. Report of the advanced team of experts mandated by the 16. Lambrichs LL. Nous ne verrons jamais Vukovar [We will never see Vukovar]. United Nations to assess the needs for a human rights monitoring mission in Paris: Philippe Rey; 2005. Haiti. New York: 1993: UN Document A/47/908. 17. Brauman R. Penser dans l’urgence. Parcours critique d’un humanitaire 32. What is Health as a Bridge for Peace. WHO Health as a Bridge for Peace [Thinking in emergencies: auto-critique of a humanitarian]. Paris: Seuil; 2006. Project. Geneva: World Health Organization; 2006. Available from http:// 18. Lambrichs L, Thieren M. Dayton plus ten: Europe interrogated. London: Open www.who.int/hac/techguidance/hbp/about/en/print.html Democracy; 2005. Available from http://www.opendemocracy.net/conflict- 33. Hess G, Pfeiffer M. 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Available from: http://www.humansecurity-chs. 21. Macrae J, Harmer A. Good humanitarian donorship: a mouse or a lion? org/finalreport/ London: Overseas Development Institute; 2004 Humanitarian Practice 36. Horton R. Iraq: time to signal a new era for health in foreign policy. Lancet Network 24. Available from: http://www.odihpn.org/report.asp?ID=2558 2006;368:1395-7. 22. Evolution of funding by sector over the last 8 years, 1999-2006. Relief Web. Available from: http://ocha.unog.ch/fts2/by_sector.asp224 Bulletin of the World Health Organization | March 2007, 85 (3)

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