WHO CONFERENCE 2021 CORNELL MODEL UNITED NATIONS
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CMUNC 2021 Secretariat Secretary-General Malvika Narayan Director-General Bryan Weintraub Chief of Staff James “Hamz” Piccirilli Director of Events Alexandra Tsalikis Director of Outreach Akosa Nwadiogbu Director of Communications Annie Rogers Director of Finance Daniel Bernstein Director of Operations Andrew Landesman Under-Secretary Generals Robyn Bardmesser Avery Bower John Clancy Mariana Goldlust 3
From Your Chair Dear Delegates, My name is Sarah Prokop and I will be your Chair for the World Health Organization committee for CMUNC 2021. I am currently a senior studying Industrial and Labor Relations with minors in Global Health and Law and Society. We are all excited to welcome you to CMUNC 2021 and cannot wait to start debate! I have been involved in Model UN since 2014 when I joined my high school’s club. Currently, I am the President of the Cornell International Affairs Society, which is the parent organization of CMUNC. I have also participated in Model UN in various other capacities as a delegate, Vice President of Membership, and as a Chair for CIAC and CMUNC. In addition to my involvement in Model UN, I am a member of the Cornell Political Union and Epsilon Eta. The World Health Organization is the leading international body dedicated to issues related to health and providing access to care. Actions taken by the World Health Organization serve vulnerable populations, further international health responses, and try to achieve universal health coverage. Through this committee, is it crucial to uphold the values of the World Health Organization, since they are critical to the success of its interventions. The two topics before this committee include: Maternal health in Africa, and Health Concerns of Displaced People. I hope that during the course of the conference you are able to implement your writing, debate, and research skills to the best of your ability in order to have successful committee sessions and productive discussions. The rest of the CMUNC 2021 staff and I are looking forward to working with you and hope that you all have a great time! If you have any questions or concerns about CMUNC 2021 or the WHO Committee, please feel free to email me at smp366@cornell.edu. All the Best, Sarah Prokop WHO Chair CMUNC 2021 4
Topic 1: Maternal Health in Africa Statement of Problem UN Sustainable Development Goal 3 targets improving health and well-being. Goal 3 encompasses reducing the global maternal mortality ratio and ensuring reproductive health care services. The provisions outlined in Sustainable Development Goal 3 have provided a solid framework for improving maternal health both globally and regionally. The maternal mortality ratio has dropped by 45% since 2013. In Eastern and Southern Asia, and Northern Africa, maternal mortality has dropped by 66%. Other statistics from the United Nations include a 15% increase of deliveries in developing countries being attended by skilled health personnel, and the rural-urban gap of skilled care during childbirth has been narrowed. Moreover, there have been considerable strides made in providing universal reproductive health care. For example, antenatal care (healthcare a woman would receive during their pregnancy) increased from 65% to 83% by 2012 (United Nations). However, there is still significant work to be done. Between 1990 and 2013, the global maternity ratio only declined by 2.6% a year, far from the targeted 5.5% per year to achieve the fifth millennium goal (WHO, 2014). According to the United Nations, maternal mortality in developing regions is still fourteen times higher than in developed regions, and still only half of women in these regions are receiving the recommended health care plans. Though fewer teens are having children and more contraceptives are being used, these trends in lowering maternal mortality have plateaued considerably. Finally, though the need for family planning is being addressed internationally, demand continues to increase rapidly and the Official Development Assistance for maternal health remains low (United Nations). The risk of maternal mortality is highest in adolescent girls under fifteen years old especially in developing countries. Maternal mortality is largely as a result of complications during and following pregnancy that include severe bleeding, infections, high blood pressure during pregnancy, complications during childbirth and abortions (WHO, 2014). The largest proportion of maternal deaths represents inequality to access to health services as well as socio- economic inequality. Women in poor, remote areas such as Africa or South Asia are more likely to receive inadequate health care. Only 46% of women in low- income countries actually receive skilled medical care during pregnancy and childbirth. This disparity between high-income and low-income countries can be shown the level of antenatal care visits, where almost all women in high- income countries go to four antenatal doctor visits, while only a third of women 5
in low-income countries go to four antenatal doctor visits. Finally, other circumstances that prevent women from receiving health care are distance, lack of information, lack of actual health care services, and cultural practices. According to the World Health Organization, 95% of all maternal deaths occur in developing countries and more than half in sub-Saharan Africa (WHO, 2014). Specifically in sub-Saharan Africa, women have a 1 in 16 chance of dying during childbirth, which is drastically lower than the 1 in 4,000 risk in a developing country (UNICEF, 2012). At 429 deaths per 100,000 live births, Africa lags behind all developing regions which have statistics of 240 deaths per 100,000 live births. The ten countries with the highest maternal mortality ratios are in Africa. For example, Nigeria accounted for 14% of total global maternal deaths in 2010. As one can see in the subsequent chart, published in the article “Millennium Development Goals Report 2013” by the United Nations Economic Commission for Africa only two countries are on track for completion of the Millennium goal of maternal health, with ten countries having no progress whatsoever. Clearly, maternal health is a pertinent issue especially in Africa and must be addressed. It is also important to note the strides that have been made since then through the Sustainable Development Goals. Significant reduction have been made in regards to maternal deaths, and improvements have been made in maternal health and reproductive health services. 6
Haemorrhage is the leading cause of maternal death in Africa and in Southern Africa, HIV/AIDS is also a top cause of death. Malaria is the leading indirect cause of maternal mortality in Africa. However, more pressing than these medical issues is the lack of health service providers. According to the same “Millennium Development Goals Report 2013”, Southern, East, Central and West Africa have fewer than 5 doctors per 100,000 people which is much below the internationally recognized 20 doctors per 100,000 people. The report attributes a major contributing factor as the distribution of health care workers. Apparently, healthcare workers density is highest in urban cities with more resources and higher income. Another factor includes the lack of medical supplies in rural areas (UNECA, 2013). In 2010, former UN Secretary-General Ban Ki-moon launched a “Global Strategy for Women's and Children's Health” in which maternal health, especially in Africa, comprises a large portion of this global strategy. This Global Strategy is a road map that identifies the finance and policy changes needed, as well as critical interventions that can truly impact the health of mothers and their children. It lays out an approach for global, multilateral, bilateral, regional and multi-sector collaboration. And of course, The World Health Organization as 7
well as UNAIDS, UNICEF and other organizations have become partners in this global strategy and is working very intimately with the United Nations. Many nonprofits and NGOs such as the Bill & Melinda Gates Foundation, the GAVI Alliance, and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria have also partnered with the team to ensure integration of services and efforts to make international collaborative actions fully comprehensive. In a Press Release by the United Nations, the Prime Minister of the United Republic of Tanzania stated that “The Government of the United Republic of Tanzania is highly committed to achieving Millennium Development Goals four and five and fully supports the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health (United Nations, 2010).” “The United States congratulates the Secretary-General for this remarkable effort, both for the breadth of partners he has convened — including governments, multilateral organizations, civil society organizations, philanthropists, and corporations — and for the substantial commitments made in response to his call for action,” said United States Secretary of State Hillary Clinton (United Nations, 2010). This is just an example of an international action-directive that has rippling effects in terms of improving maternal health not only in Africa, but around the world. Possible Solutions In a statement by the World Health Organization, they stated that “To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system (WHO, 2014).” It will be up to the delegates to identify and address issues pertinent to the problem of maternal health in Africa, especially through further research. The WHO is currently working to reduce maternal mortality by “providing evidence- based clinical and programmatic guidance, setting global standards, and providing technical support to Member States (WHO, 2014).” The WHO also advocates for affordable and effective medical treatment, medical training, and medical resources. Many other cost-effective methods can be used to improve maternal health in Africa. As malaria is a major cause of deaths during pregnancy and childbirth, affordable and effective solutions include preventive treatment and insecticide- treated bed nets. This is a big issue, as they are often not available where needed most and it would be up to the World Health Organization to coordinate and fund such an undertaking. Furthermore, many maternal deaths occur due to poor access to reproductive health services, and an idea that has been bounced 8
around the international community and the World Health Organization is making progress in achieving universal access to reproductive health (UNECA, 2013). Of course, this will be a heavy investment of World Health Organization resources so it would be up to the delegate’s prerogatives if this something they wish to pursue. About 50% of deliveries in Africa occur in the home outside of a healthcare facility, so increasing the number of skilled birth attendants to care for mothers during delivery would increase maternal safety (ONE, 2013). Increasing the time between births will lower maternal mortality. Better distribution of the four central medications (oxytocin, misoprostol, magnesium sulfate, and manual vacuum aspirators) that combat the leading causes of maternal mortality would also reduce frequency. Improved transportation would enhance access to health facilities, especially for women who live in more rural areas. Educating women so they know when to seek healthcare services during or soon after delivery is vital to improving maternal health. Educating men (husbands, politicians, community and religious leaders) is also important in the fight against maternal mortality. If men are well-informed about potential risks and complications, the likelihood that future births will occur in health care facilities rises (Bathala, 2013). Bloc Positions Africa: Countries of Sub-Saharan Africa are extremely supportive of measures to improve maternal health. Since women make up more than half of the population of the majority of Sub-Saharan Africa’s countries, high maternal mortality will restrict human and socio-economic development. Improving maternal health would also mean mothers can “effectively involve themselves in the development process of the continent (Zuma, 2012).” Sub-Saharan African countries are extremely supportive of improving maternal health for women to achieve a sustainable track for progress. United States: The United States is a huge supporter of improving health in Africa, specifically ending preventable maternal deaths. By 2035, the U.S. hopes to reduce preventable maternal deaths to less than 50 per 100,000 live births (Office of the Press Secretary, 2014). Former Secretary of State Hillary Clinton previously assured $75 million in U.S. support for improving maternal health in Africa. A joint initiative between the U.S. and Norway centers on labor, delivery, and the first 24 hours post-birth when the majority of maternal deaths happen (Stearns, 2012). Although the U.S. is in support of advancing maternal health in Africa, Clinton had stated that each country must “shape its own approach based on individual needs and priorities (Stearns, 2012).” In 2012, the United States, 9
India, and Ethiopia hosted a forum called Child Survival Call to Action in support of a global end to preventable child deaths and increased progress on maternal health (Office of the Press Secretary, 2014). Asia: Countries in the Asian bloc are also strong advocates for increasing maternal health in Africa. For example, at the Fifth Tokyo International Conference on African Development (TICAD V), Japan pledged their support to major African programs to advance maternal health (United Nations Population Fund, 2013). These initiatives include the Campaign on the Accelerated Reduction of Maternal Mortality in Africa and the Plan of Action on Sexual and Reproductive Health and Rights. 10
Topic 2: Health Concerns of Displaced People Statement of Problem The UNHCR (United Nations High Commissioner for Refugees) stated that, “It has been aptly said that ‘refugee emergencies kill’.” The Rwandan genocide of 1994 resulted in the displacement of over one million Rwandan refugees who fled to the Democratic Republic of the Congo, previously known as Zaire. There, a quarter of the children were diagnosed with acute malnutrition and around 50,000 refugees died in just a matter of weeks primarily due to cholera (UNHCR, 1995). This is just one instance of the paramount problem that is the health of displaced people. The complexity of this issue firstly stems from the multiple definitions of “displaced peoples” and the various reasons for their displacement. According to the World Health Organization, displaced people include both people who remain in their own countries, known as Internally Displaced People (IDP) as well as people who cross international borders, known as refugees (WHO, 2015). The UNHCR, further defines displaced people into Stateless People as well as Asylum-Seekers. The international legal definition of a “Stateless Person” is outlined in the 1954 Convention relating to the Status of Stateless Persons as “a person who is not considered as a national by any State under the operation of its law.” According to the UNHCR, such a person is essentially someone who does not have a nationality of any country (UNHCR, 2015). In terms of asylum-seeker, the UNHCR differentiates asylum-seekers as one who “says he or she is a refugee, but whose claim has not yet been definitively evaluated (UNHCR, 2015).” As one can conclusively see, the different statuses of “displaced people” can make creating a comprehensive international protocol for healthcare extremely difficult. Moreover, the extenuating circumstances in which these people are forced out of their homes differ extensively from crisis to crisis. In terms of the Rwandan genocide displacement was due to politics and civil-war, “Within a few days after it began, there were seven hundred thousand refugees in Goma and another four hundred thousand at other camps in Zaire. More than half a million more flooded into Tanzania. Another quarter of a million chose Burundi. These are all countries that have difficulty caring for their own people and they were immediately overwhelmed, wrote journalist Stephen Kinzer (Rwandan Stories).” 11
In terms of the refugee crisis due to the Fukushima Nuclear Disaster, displacement was due to problems in national infrastructure. A New York Times article states that “Two and a half years after the plant bleached plumes of radioactive materials over northeast Japan, the almost 83,000 nuclear refugees evacuated from the worst-hit areas are still unable to go home (Fackler, 2013).” Displacement can also be caused by environmental crisis, as in the case of the Indonesian Tsunami of 2004, where “according to the Indonesian government’s disaster coordinating agency, BAKORNAS, by the end of March 2005, 128,645 people in Aceh had lost their lives, 37,063 were missing and 532,898 had been displaced (Roofi et al., 2006).” There are many other examples of displaced people, such as caused by the dissolution of the Soviet Union, which led to statelessness in more than 267,000 people in Latvia and 91,000 in Estonia still as of 2013 (UNHCR, 2015). Clearly, each of these circumstances leave displaced people with different medical needs, it is up to the delegates of the World Health Organization to now differentiate between these different medical circumstances and adequately address each in a holistic manner. 12
Case Studies Boxing Day Tsunami A study conducted by the Johns Hopkins Bloomberg School of Public Health investigated “Tsunami mortality and displacement in Aceh province, Indonesia”. Aceh province was the most heavily hit region of the Tsunami that resulted from the earthquake. This study found that of a pre-tsunami population of 338,985 people, 30,564 internally displaced persons were residing in more than 30 locations in 10 sub-districts of Aceh Barat around a month after the Tsunami. This study reported an average number of deaths reported in Internally Displaced Households as 0.8 (SD of 1.3). Mortality risk among females was 1.9 times greater than men and higher mortality rate was observed in the oldest and youngest age groups. Finally, in IDP households displaced by the tsunami, the overall tsunami mortality rate was 13.9% (Roofi et al., 2006). According to the World Health Organization, many hospitals and health centers were destroyed and damaged. Water supplies were disrupted and contaminated, sanitation and sewage treatment works were damaged. People were at risk of Diarrhoeal diseases, while diseases such as salmonellosis, typhoid, cholera, 13
hepatitis, and shigellosis were also large problems especially in temporary camps which also lacked adequate sanitation. Measles and acute respiratory infection were also feared due to overcrowding. Furthermore, the WHO observed injury-related tetanus as a serious initial threat, with mosquito-borne disease as a later threat. Moreover, many individuals suffered from social and mental distress (WHO). However, international response to the disaster made the disaster largely manageable. In response to this disaster, more than $9 billion was raised internationally, with the U.S. military offering $250 million worth of support across the region. This international response was documented as the “largest privately funded emergency” (Akkoc, 2014). In its three month report, the World Health Organization outlined its response to the event, “As WHO became aware of the scale of the disaster it focused, quickly, on the potential health threats faced by the survivors, and the risk that they might suffer - or even die - as a result of disease. WHO provided support for a collective response and identified as a primary objective the support to national health authorities so as to protect the health of survivors - particularly the most vulnerable people (WHO).” The WHO activated the Global Outbreak Alert and Response Network (GOARN) in which disease surveillance and response experts were posted to Tsunami-affected areas to manage communicable diseases. Other initiatives of the WHO included assessing the health situation, coordinating health actors, and building national capacities to deal with crises (WHO). What also contributed largely to the successful international response to the Boxing Day Tsunami was international coordination and support. A few weeks after the Tsunami, the UNHCR distributed more than 20,000 pieces of plastic sheeting, 25,000 mats, more than 15,000 articles of clothing, and around 8,000 mosquito nets (UNHCR, 2005). Essential supplies like these are largely beneficial to the health of displaced peoples. Lastly, the Boxing Day Tsunami did highlight areas of improvement to healthcare systems, “in particular, the ways in which the health sector should prepare for future natural disasters including intersectoral cooperation, infrastructural preparedness, and sensitivity to local knowledge (Carballo, 2005).” Syrian Refugee Crisis The story of Syrian Refugees as a result of the Syrian Civil War paints a more grim picture than that of the Boxing Day Tsunami. As of August 2012, the UNHCR reported that the number of registered Syrian refugees had reached 14
over 200,000 (BBC, 2012) and the United Nations reported 4 million Internally Displaced Peoples (Memmott, 2012). For example, due to a severe lack of international support, many Syrian refugees in Lebanon are unable to access medical care according to Amnesty International. In some situations, refugees have returned to Syria to receive medical attention. Some Syrians have been turned away from hospitals. “‘Hospital treatment and more specialized care for Syrian refugees in Lebanon is woefully insufficient, with the situation exacerbated by a massive shortage of international funding. Syrian refugees in Lebanon are suffering as a direct result of the international community’s shameful failure to fully fund the UN relief programme in Lebanon,’ said Audrey Gaughran, Director of Global Thematic Issues at Amnesty International (Amnesty International, 2014).” The health system in Lebanon is highly privatize and expensive, leaving many refugees reliant on subsidized fees from the UNHCR. However, to due to shortage of funds, Arif, a 12-year-old boy who suffered severe burns on his legs, which swelled and became infected, was only able to have the UNHCR cover the cost of his treatment for five days. “‘It’s time for the international community to recognize the consequences of its failure to provide adequate assistance to refugees from the conflict in Syria. There is a desperate need for countries to fulfil the humanitarian appeal for Syria and step up efforts to offer resettlement places for the most vulnerable of refugees, including those in dire need of medical treatment,’ said Audrey Gaughran (Amnesty International, 2014).” In a United Nations report, The refugee crisis has increasingly strained health services in surrounding countries. The report which covers the first three months of 2013 in Iraq, Jordan and Lebanon shows more than 1 million refugees that need medical attention. The United Nations asserts the cause of the two problems to be low funding for the refugee crisis and the increasing numbers of people needing medical help is straining existing health services. Former UN Secretary-General Ban Ki-Moon has called upon the Security Council and countries in the region to draft a unified position to persuade greater international support. He says, “We risk an entire generation of children being scarred for life. The children of Syria are our children. They need our help.” (United Nations, 2013). 15
Still, the international community is providing support for Syrian refugees. In the Zaatari camp in Jordan, the World Health Organization and its partners continue to implement and introduce a number of health initiatives. The main concerns of these refugees residing in camps include “upper respiratory tract infections, diarrhoea, and skin conditions. Chronic diseases include gastrointestinal complaints, hypertension, asthma, diabetes and cardiovascular conditions.” The WHO also completed nutritional assessment of children under the age of five and women. The WHO is also working with the Ministry of Health to implement a deworming campaign that administers 250,000 deworming tablets to school children in order to address intestinal parasites. The WHO and UNICEF are planning the measles and polio immunization campaign for Irbid and Mafraq (WHO). 16
Possible Solutions After recent studies were carried out it was discovered that the most pivotal concern amongst the health needs of displaced people was to maintain their reproductive health specifically in adolescents and women. In June 1995, an inter-agency symposium was conducted on the reproductive health of displaced people, specifically refugees, and it went on to conclude that certain reproductive health needs have not yet been dealt with. Furthermore it went on to pinpoint the important need to deal with aspects ranging from: • Safe motherhood • Family planning service • Control of sexually transmitted diseases such as HIV/AIDS • Management of sexual and gender based violence • Overall primary health care services For whichever country the displaced people are residing in, the host country’s government has the crucial responsibility for providing for them. There have been several instances where the host governments are unlikely to help immediately when a displacement has to occur due to a lack of resources available. Help from the outside is essential and must be provided to the host government, though, it must be done sustainably and with the idea that eventually the integration of health services must be done simultaneously. Emergency interventions would therefore benefit from a primary health care (PHC) approach, which would emphasize preventive programs. There would also be a greater involvement of the displaced people in the provision of these health services and effective coordination as well as information gathering must always be maintained. A PHC approach seems to offer greater longevity both for the host country and the displaced population as well, whilst simultaneously being cost-effective when dealing with the health and nutrition of the displaced people. The World Health Organization has a duty to make sure constant coordinated and sustained efforts as well as an optimal use of resources occurs when dealing with displaced people. These include the Centers for Disease Control and Prevention (CDC), in order to develop common objectives, standards, priorities and a strong network of professional support. Furthermore, NGOs must also be considered in implementing the solutions that are thought of related to displaced people (WHO, 2015). 17
Bloc Positions Considering the fact that this is primarily a social topic with a slight political aspect, the bloc positions would not be as stark. However, there are always different approaches taken amongst certain groups of countries. To consider those approaches these are the likely bloc positions: • The Western bloc: North American countries, European countries, Generally South American countries • The African bloc: Generally consisting of all the African countries • The Asian bloc: China, Russia, Generally Central Asian countries, Brazil, South Africa, India Issues to Consider Aside from the conventional problems of displaced people in refugee camps such as water-borne diseases, waste management, crowding and dead bodies, which delegates are absolutely expected to address, some more unconventional problems are brought up throughout this background guide. These should be the focus of any resolution and discussion of the World Health Organization, which includes: • Funding: A lot of the crises that occur that displace people either internally or internationally do not receive adequate funding from the international community or NGO’s such as the World Health Organization or UNICEF. It is up to the delegates to discuss provisions that will adequately fund any crises that may occur. As one might see, money is the first priority as a well-funded humanitarian response will dramatically reduce mortality rates of refugees as seen in the Boxing Day Tsunami case study. • Women and Children: As also seen in the Boxing Day Tsunami case study, women and children are at severe risk of mortality during crises. Delegates are expected to find realistic solutions that target the health of women and children. • Mental Health: Mental Health in displaced people due to crisis, whether it is environmental or political, is extremely important and an often overlooked health issue. A Washington Post article follows the story of Amira, who saw her uncle bleed to death, her home shattered by shells and her arm struck by burning shrapnel. After, she had stopped eating, her muscles atrophied and legs no longer able to bear her weight. Amira’s case offers a small glimpse into the devastating mental-health crisis that is taking hold among Syria’s refugees, especially children. There is no 18
mental-health infrastructure in Lebanon, and most aid organizations lack the expertise and resources to provide therapy and treatment to children who witness brutality (Shaheen, 2014). Again, the delegates of the World Health Organizations are especially encouraged to discuss and provide a comprehensive solution to address mental health, which has otherwise not been discussed on an international forum. • Unregistered Displaced People: Moreover, a lot of refugees are not registered with organizations such as the UNHCR, Red Cross or World Health Organization. This provides an extremely complicated problem as these displaced people severely need medical attention, but are unable to even conceive of receiving treatment because they are unregistered. These problems are largely due to lack of logistical capacity of these organizations or lack of knowledge and awareness on part of the refugees. Much improvement is needed on this front in order to help a large portion of unknown displaced people. • People Without Identities: As stated above, a “Stateless Person” is also considered a displaced person. A stateless person does not have national identity and finds it extremely difficult to obtain a national identity. This is a problem in the sense that a stateless person will not have the necessary documentation to obtain proper health care. It is up to the delegates of this committee to again, come up with innovative solutions that will target these specific people and provide long-term solutions. • Lack of Medical Infrastructure: This is pretty self explanatory. Many countries that host refugees or internally displaced people lack the proper medical infrastructure to deal with the influx of human population. Moreover, many countries do not have the proper guidelines and preparation to be able to accommodate an extenuating crisis such as the Rwandan Genocide or Fukushima Nuclear Incident. It is up to the World Health Organizations to provide the necessary medical infrastructure including personnel in case of an international crisis. • National Sovereignty: Of course, under the mandate of the United Nations, delegates must be wary of national sovereignty. For example, it would not be under the mandate of the World Health Organization to reform the healthcare system of Lebanon to better support Syrian refugees. Instead, the World Health Organization may provide recommendations or incentives, or create its own programs to deal with the needs of Syrian refugees. Ultimately, the decisions of healthcare in Lebanon is up to Lebanon itself but remember, diplomacy and international cooperation is the guiding force of all nations in the WHO. Any resolution passed by the WHO must take into account national sovereignty. = 19
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