On June 7-8, the International Peace Institute and the Global Health Centre of the Graduate Institute held a retreat on “Doctors in War Zones: International Policy and Health Care in Armed Conflict.” The goal was to outline the wide variety of challenges that health actors face in conflict-affected settings, and discuss ways in which we can rethink and redefine existing collaboration models, governance structures and accountability mechanisms for international health and humanitarian actors to ensure the adequate delivery of health services in such settings. The retreat was attended by representatives of country missions to the UN and other international organizations in Geneva, global health and humanitarian experts from the UN and other international organizations, as well as academics.

In the first session, the experience of individuals providing health services in conflict-affected settings was put front and center. Participants also highlighted challenges such as the difficulty of providing chronic care in conflict-affected settings, the inadequate prioritization of programs, and the impact of contemporary counterterrorism measures.

The second session on health governance systems outlined the existing structures and procedures that guide the international health response in such settings, with a focus on the functioning of the UN cluster system, the L3 Activation Procedure and the role of the WHO. Key challenges highlighted were the use, in protracted crises, of structures that were designed for the short-term, insufficient flexibility and fluidity of the existing system, and the difficulty of transitioning to government-led responses.  Several participants pointed to ways of better working with the existing system, including by better engaging local actors and leveraging outside voices, ensuring that the right people are being hired, and suggesting that civil society actors do more to hold governments and UN bureaucracies to account. Accountability, or the lack thereof, was identified as a key issue in existing health governance systems.

In the final session, participants discussed various types of accountability for health services provided in conflict-affected settings, from performance, to financial and international accountability. The over-emphasis on accountability to donors as opposed to accountability to affected populations was highlighted, as well as the need for stronger community engagement. A series of concrete possible way forwards to ensure better accountability were put forward, including setting up an inter-agency humanitarian healthcare governance project, and having an independent auditing body administer accountability on behalf of affected people.

This retreat was part of a broader research project conducted by IPI on these issues which will result in a final policy report.

Written by Alice Debarre on behalf of the International Peace Institute