Kennedy Jonathan, Michailidou Domna
Global Health Unit, Queen Mary, University of London, UK and.
Economics Department, Organization for Economic Co-operation and Development (OECD), and Centre for Development Studies, University of Cambridge, Cambridge, UK.
Health Policy Plan. 2017 Jun 1;32(5):690-698. doi: 10.1093/heapol/czw148.
States and the World Health Organization (WHO), an international organization that is mandated to respect the sovereignty of its member states, are still the leading actors in global health. This paper explores how this discrepancy inhibits the ability of global health partnerships to implement programmes in conflict-affected areas that are under the de facto control of rebel organizations. We concentrate on a single crucial case, the polio outbreak in Syria in 2013, analysing a variety of qualitative data-twenty semi-structured interviews with key actors, official documents, and media reports-in order to investigate the events that preceded and followed this event. The WHO's mandate to respect the Syrian government's sovereignty inhibited its ability to prevent, identify and contain the outbreak because the Assad regime refused it permission to operate in rebel-controlled areas. The polio outbreak was identified and contained by organizations operating outside the United Nations (UN) system that disregarded the Syrian government's sovereignty claims and cooperated with the militants. Thus, we identify a serious problem with so-called global health partnerships in which nation states and international organizations remain key actors. Such initiatives function well in situations where there is a capable state that is concerned with the welfare of its citizens and has exclusivity of jurisdiction over its territory. But they can encounter difficulties in areas where rebels challenge the state's sovereignty. Although the response to the Syrian polio outbreak was ultimately effective, it was reactive, ad hoc, slow and relied on personnel who had little experience. Global health partnerships would be more effective in conflict-affected areas if they put in place proactive and institutionalized plans to implement their programmes in regions outside government control.
各国以及世界卫生组织（WHO），一个被授权尊重其成员国主权的国际组织，仍然是全球卫生领域的主要行为体。本文探讨了这种差异如何抑制全球卫生伙伴关系在受冲突影响地区实施项目的能力，这些地区实际上处于反叛组织的控制之下。我们专注于一个关键案例，即2013年叙利亚的脊髓灰质炎疫情，分析各种定性数据——对关键行为体的20次半结构化访谈、官方文件和媒体报道——以调查该事件之前和之后发生的事情。WHO尊重叙利亚政府主权的授权抑制了其预防、识别和控制疫情的能力，因为阿萨德政权拒绝其在反叛组织控制地区开展行动的许可。脊髓灰质炎疫情是由在联合国（UN）系统之外运作的组织识别和控制的，这些组织无视叙利亚政府的主权主张并与武装分子合作。因此，我们发现了所谓全球卫生伙伴关系中存在的一个严重问题，在这种伙伴关系中，民族国家和国际组织仍然是关键行为体。此类举措在存在一个关心其公民福利且对其领土拥有排他性管辖权的有能力的国家的情况下运作良好。但在反叛组织挑战国家主权的地区，它们可能会遇到困难。尽管对叙利亚脊髓灰质炎疫情的应对最终是有效的，但它是被动的、临时的、缓慢的，并且依赖于几乎没有经验的人员。如果全球卫生伙伴关系制定积极主动且制度化的计划，以便在政府控制之外的地区实施其项目，那么它们在受冲突影响地区会更有效。
