Around the world, we are increasingly socially and economically interdependent. Health on one side of the globe affects people on the other. Global health, once merely an ethical consideration, now dominates discussions and policies of global security. A diverse team of experts in this emerging field has come together to help you contextualize your experiences as a new or seasoned global health responder. By the end of this course, you will be enlightened about the changing world you live in, and have a much better understanding of the machinations on how organizations and governments are striving to improve health worldwide. You'll also learn how to keep yourself safe and be a savvy participant in the global health arena. You'll be prepared to travel and to take your skills to chronic/emergent situations and help respond to the pressing needs while participating in global health activities throughout the world. Week one will serve as an introduction to global health concepts with a look at changing trends in the 21st century; urbanization, environmental stress and resource scarcity. During week two, we will dive into global health security: food, water, energy, and the threats of a changing climate. Week three will cover the global burden of disease, infectious disease, the rise of non-communicable diseases, mental health, and access to care. During week four, we will learn about the stakeholders in global health: NGOs, governments, non-state actors; understanding where the money comes from, how it is allocated and the challenges of measuring results; human rights: what are they and how are they protected? During week five, we move onto complex humanitarian emergencies: forced migrations, wars, response standards, and the legal basis for interventions. Finally, during week six, we will end our course by learning how to be an effective participant--caring for yourself: pre-travel preparation, understanding risks when traveling outside your home country, and physiologic vulnerability. This course also serves as a prerequisite to the hands-on 'Global Health Responder' certification from the University of Colorado School of Medicine. If you're interested in taking this 3-day hands on course-- offered throughout the world-- please go to coloradoWM.org or email our administrator: marisa.burton@ucdenver.edu.
19 - Satchit Balsari - Legal Basis for Aid and Intervention
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Fundamentos da Saúde Global para Iniciantes
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Stakeholders
You've now learned about emerging global health threats, climate change in global health, the 'preconditions' of health, and disease burden. We're over the halfway point, and now it's time to meet the stakeholders-- the players, if you will who shape how global health is financed and how programs are prioritized and executed. Arlan Fuller talks us through the legal and moral constructs that underpin global health activities, and then we'll meet Dr. Satchit Balsari, who will interview Skip Burkle on the legal basis for giving aid-- very much setting the stage for week 5 when we focus on humanitarian crises. Dr. Balsari will finish the week by discussing the established standards in humanitarian activities-- i.e. the guidelines that humanitarian responders are expected to withhold.
Conheça os instrutores
Dr. Jay Lemery, MDAssociate Professor
Emergency Medicine, University of Colorado School of Medicine
Dr. Satchit Balsari is head of Global Emergency Medicine at
the New York Presbyterian Hospital, Weill Cornell Medical College in New York City.
He has acted as a consultant to the American Red Cross and UNICEF, and
has founded two nonprofit organizations in Mumbai, India, and
is a fellow of the Harvard Humanitarian Initiative.
He graduated from the Grant Medical College of the University of Mumbai and
has obtained an MPH from the Harvard School of Public Health.
Humanitarian relief and
aid is based on a set of laws and rules that every humanitarian should know well.
These laws began in 1864 with the first Geneva Conventions which
protected the sick and wounded soldiers.
By the end of World War II the international community realized there was
a need for even greater protections of not only soldiers, but
also civilians affected by conflict.
This led to the founding of the United Nations and ratification of
the Geneva Conventions as a standard for international humanitarian law.
In this talk, Dr. Balsari will outline the foundations of these laws.
And afterwards, he interviews Dr. Skip Burkle to learn about Dr.
Burkle's years of experience with international humanitarian law and
how he has seen these laws used to provide aid.
He also provokes some insight into the questions such as,
how does the UN enforce these laws?
Especially in the midst of a conflict, or if perpetrators
are groups such as ISIS rather than an internationally recognized nation.
We learn that while these laws are an essential part of humanitarian relief,
their implementation and
enforcement becomes increasingly complicated in the modern world.
>> Hi. Today we are going to learn about
international humanitarian law, and familiarize ourselves with terms like the
Geneva Conventions, the Hague Convention, terms that you've heard before.
I'm Satchit Balsari from Weill Cornell Medical College.
And this is Professor Skip Burkle,
whom you've met in this series from the Harvard Humanitarian Initiative.
As we begin to explore international humanitarian law or Geneva Conventions,
I think it is important to first recognize where they started,
where they came from, and why we need to know this material.
When we look around the world today and
we see people suffering from calamity and conflict,
we also see groups of humanitarian aid workers helping them all around the world.
Whether people are suffering from hurricanes or disasters, or,
or complex humanitarian emergencies, we always see the banners of all these
organizations ranging from UN agencies like UNICEF and
UNHCR as well as aid organizations like MSF
the International Rescue Committee, Mercy Corps, always at the front lines.
Most of us think that the impetus behind this aid is, is merely altruistic.
It certainly is altruistic.
But we provide aid to these people, not because
it is the good thing to do, but it is because it is their right to be protected.
We as an international community have agreed
that people suffering from disasters, whether natural or
man-made, have a right to life with dignity and have a right to be protected.
This right that we now take for granted in 2014 wasn't always so.
And what we hope to cover in the next few minutes, very quickly,
is this journey that the world has undertaken collectively,
especially over the last 150 years, if not for centuries before,
where we have together agreed that these suffering people need to live a right,
or have a right to life with dignity, and have the right to be protected.
I mentioned international humanitarian law.
International humanitarian law is a set of rules that seeks to protect people
affected by war, either military personnel not engaged in conflict anymore,
or civilians affected by war.
It can largely be thought of in two groups,
the Law of Geneva and the Law of Hague.
The Law of Geneva is designed to protect people affected by the war,
so either the soldiers who are not fighting again or civilians.
The Law of The Hague is essentially aimed at belligerents fighting the war,
and it defines the terms within which war can be fought.
The Law of the Hague is what would talk about, what weapons to use,
what weapons not to use, what's acceptable and not acceptable as a practice of war.
The Law of Geneva is to do with humanitarian aid,
which is what we're going to talk about today.
In 1864, few years after he Battle of Solferino,
Henry Dunant and four of his colleagues spearheaded a movement which is now known
as the International Committee of the Red Cross.
That is the guardian of the Geneva Conventions, and
that first ratified what was, what is now known as the first Geneva Convention.
It was signed by 16 countries, and it was revolutionary at that point.
Because there were always codes of conduct for
war, dating back hundreds of years in religious texts and
sacred texts and historical texts, but most of these applied just very locally.
This was the first time that several nation states came together and
agreed upon a general set of principles for war.
And essentially what the first Geneva Convention dealt with was
protecting soldiers that were left behind on the battlefield.
The second Geneva Convention came about in the early 20th century, when they realized
that the first Geneva Convention was largely limited to armed soldiers
on, on the battlefield, and not to armed personnel on the seas.
After the large war between the empires of Japan and Russia in 1906,
an even larger number of nation states then signed the second Geneva Convention
which dealt with protecting armed personnel as affected by war at sea.
Essentially what these Geneva Conventions said is that,
if you were injured in war and left on the battlefield,
you had a right to be protected irrespective of who found you.
Even if you were found by the enemy, you had a right,
as long as you'd put down your arms, to be protected, to be given healthcare, and
to be treated with dignity, that you cannot be arbitrarily killed or tortured.
Another decade passes, the First World War comes and goes, and we realize that
the two Geneva Conventions were insufficient to protect prisoners of war.
The third Geneva Convention addressed prisoners of war.
After the Second World War,
we learned that civilians were not covered by the preceding Geneva Conventions, and
so the fourth Geneva Convention was adopted, and it extended to civilians.
And this is very important and relevant, especially over the next 50 to 60 years
in terms of, of how the nature of war has changed.
Wars are not just fought between nations anymore.
There is strife amongst nations,
amongst populations of countries, and though civilians are,
are affected by these wars, they are not necessarily international wars.
To address this new changing dynamic of wars,
additional protocols were incorporated that together,
after 1977, form what is now known as the Geneva Conventions.
So it's essentially the first four conventions,
two additional protocols adopted after that,
that form the bulk of international humanitarian law as we know it today.
This body of law that we now have called the Geneva Conventions is extraordinarily
im, important and empowering to the humanitarian sector.
They define who humanitarian actors are, all these NGOs that we see on the field,
their role, their obligations as long as they meet the humanitarian imperative,
are covered by the Geneva Conventions.
What was interesting in those times, in the late 1940s,
after the World War, when the Geneva Conventions were adopted,
was what was happening to the international community as a whole.
The birth of the United Nations and
the adoption of probably what has been one the most profound collective document ever
written by humanity, the Universal Declaration of Human Rights.
It was for the first time that the world,
together, agreed that all human beings were equal and born free.
What was interesting about the late 1940s, in the aftermath of the Second World War,
was the birth of some very powerful international organizations,
the United Nations in particular.
And especially the formulation of the Universal Declaration of Human Rights,
one of the most profound documents written collectively by humanity.
Article One of the declaration says, all human beings are born free and
equal in dignity and rights.
What we take for granted in 2014 needed to be stated and
debated by multiple nations around the world.
The Universal Declaration of Human Rights is largely operationalized by two groups,
two covenants.
The first, the covenant on civil and political rights, and
the second on economic social and cultural rights.
Civilian political, political rights are considered completely inalienable and
non-negotiable.
These are rights that everyone, every nation state subscribes to immediately.
While the socioeconomic and cultural rights, while they're not non-negotiable,
are essentially promised in a phased
manner as countries are able to provide more services to their people.
Well we have oversimplified several decades of international law writing in
the last five minutes.
I'd like to now turn to Professor Burkle to ask him a few
questions about how best we can understand what all these laws mean.
Professor Burkle.
So we've learned about, you know we've discussed Geneva Conventions,
we've talked about the Universal Declaration of Human Rights.
Just how do we end up operationalizing all these laws?
Who does the Geneva Convention cover?
Who is bound by them?
Who is signing these conventions?
>> That's the $64,000 question, isn't it, Satchit?
Yes, of course, all the countries right now are signatories
to the Geneva Convention historically.
That doesn't mean that the government in power
truly understands the ramifications of being a signatory.
Historically we do have to go back on how important being in signatory is.
So that in World War II, the Allied troops, came from countries that were
signatories to the Geneva Convention, but Russia did not sign the Geneva Convention.
So those prisoners of war held by the Germans, the mortality rate among
the Russian prisoners of war was over 70%, I think closer to 79%.
But the mortality rate was about 17% amongst, among the Allied.
And of course, on the other side of the world, the, with the the war in, in Japan,
they were not signatories to the Geneva Conventions, and
certainly have a hist, had a history of, of, of treating prisoners terribly.
But the fact that they were not signatories to the Geneva Conventions was
their primary defense during the legal cases against those that,
that perpetrated the torture.
That they didn't know better, okay?
So the ramifications are tremendous, but, so
it's mo, should be more powerful today that everybody's a signatory.
But that doesn't mean it's going to be enforced or
the enforcement mechanisms are going to be in place, at least during the conflict.
>> I'm going to request you to elaborate on that portion right there.
And I think I have a two-part question.
Since you talked about not being a signatory, can you allude a little bit
to what customary law means then- >> Yes.
>> In this context?
>> Yes.
Customary law essentially is, is tied to Article 3, which is the common article
under the Geneva Conventions, which means that, really, every country is obliged to,
in certain, in very broad but very specific areas to, that, that are,
that entitle everybody to those rights, even though you're not a signatory.
So. >> So even if you're a new
country- >> Yes.
>> South Sudan is just born.
Is it still obliged to these?
>> Absolutely.
They are immediately covered under Article 3, the common Article 3.
>> And, and what about ISIS?
This Islamic Republic of Iraq and, and
Syria that claims that it is now a separate entity.
>> Of course-.
>> Are they bound?
>> Of course that's a question on the tip of our tongue right now.
And, and it is interesting because Al Qaeda has voiced
some displeasure with the activities of, of ISIS in the Levant, okay?
So does it mean then that Al Qaeda and its affiliates have some sense of what's
morally right and what's morally wrong in, in, in war or treating civilians?
We don't know.
We don't know enough about them.
But what's interesting, and, and, and you said it
right from the beginning Saj, and that was you gave how the Geneva Conventions one
through four has changed as we knew more about conflict and how conflicts changed.
So right now, we are looking at how does the ICRC and
the Geneva Conventions adapt to these new conflicts, the unconventional conflicts.
And they are working on it, including
what would be the responsibilities of these non-state actors?
Because the Geneva Conventions have to do with state actors, not the countries.
>> Right.
>> And so, we have non-state actors,
we have separate militaries that are not part of the state.
>> Right. >> Okay?
So, the ICRC is indeed working on those.
What would be the common rules there?
And I'm sure the Article 3 would, would come under that too.
But what obligations they would have in order to have a dialogue with them to
ensure that they start performing better in terms of, of protection for
the people around them when they have their, their war or their conflict.
But it's a big issue, but it is, it is, it is being dialogued as we talk.
>> And even if we can convince them that, that they need to
follow the Geneva Conventions, do the Conventions have any teeth?
How do we enforce that?
What do we do about violations of the, of the Geneva Convention?
Many people, many humanitarian actors have said that
Geneva Conventions were violated during the Iraq War.
What is a recourse there?
What can people do?
>> It's a step-by-step fashion.
Part of it is done by the ICRC itself, which as soon as this happens,
they separately go to the, to the governments.
One, one the, the, the hostile element
and, and tells them what the violations are, and
they give them specific times and measures to correct that.
They also communicate to the countries
that are being affected by those violations.
So they, they're sort of an intermediary between and, and, and
keeping the dialogue going.
So if they don't get any enforcement with that it's hard, okay?
The only recourse then is to put it into the international body.
So that's where these things get to, both with the Hague Law and
the Geneva Conventions, into the, into the Security Council of the United Nations.
And the two mechanisms under the original charter then
are what's called Chapter VI, which is sending peacekeepers in.
And that's not usually during hostility, but it's very important afterwards,
to, to keep, prevent the hostilities to happen again.
And, and number, and
the second one is, article, Chapter VII, which is the peace enforcement.
And that would allow then the Secretary General of the United Nations to
pull in essentially militaries from countries, not those countries
that are party to the conflict obviously, to try to come in and abate the situation.
That sometimes works, sometimes not.
Obviously it's, is very political, and if the security council says no to it,
which they often have done then it just doesn't work.
And remember, before the end of the Cold War, so we're talking about 1989,
1992, 400 and, 274 [COUGH] attempts were made in the Security Council
to bring in troops peace peace enforcement troops.
But because the Soviet Union on one side, or
the West on the other side could veto it, it didn't happen.
So the first time that,
that it was never stopped in the Security Council was in the Kurdish crisis.
>> Right.
>> And, interesting then that, either they abstained, did not veto.
And tjat all of a sudden the lap was in the, the, the, the, the capacity or
the demand to do this was put in the lap of the United Nations.
And the United Nations does not have, did not have a force at that time to stop it.
So, quite honestly, they contracted with the United Nations, and the UK and others.
It ended up four countries and, and expanded to thirteen, who then were
working under the flag of the United Nations to stop that hostility, to protect
the Kurds that were in the mountains of Northern Iraq and, and Southern Turkey.
So there's lots of different possibilities, but that's the kind of
thing that would be then negotiated within the Security Council itself.
>> Thank you Professor Burkle.
The point of that discussion was to give us a glimpse of how complex these
issues can be.
We very quickly breezed through 150 years of history of the international
humanitarian law, its genesis, its execution, its implementation.
And we are at an extremely interesting juncture right now
where the Geneva Conventions,
international humanitarian law are struggling to be relevant.
In 2014, the UNHCR declared that there are more refugees today than there
have ever before, after World War II.
Imagine where these millions would be if we did not have international humanitarian
law to protect them.
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