How did Syria win a seat on the WHO’s Executive Board despite its appalling record of attacks on healthcare?

AMMAN — On May 28, Syria was elected to the Executive Board of the World Health Organization (WHO) for a three-year period, along with Afghanistan, Belarus, Denmark, France, Japan, Malaysia, Paraguay, Peru, Rwanda, Slovenia and Timor-Leste.

Many civil society and humanitarian organizations have since denounced this baffling move, citing the Syrian regime’s extensive record of weaponizing healthcare. In Idlib, vigils were organized in front of several health centers in protest.

“We are appalled by the WHO’s decision to reward the Assad regime for destroying hospitals and killing doctors and refusing to provide medical assistance to Syrians by electing it as a member of its executive board for 3 years,” the White Helmets, an internationally recognized volunteer civil defense organization operating in opposition-held areas, tweeted the next day. 

The White Helmets have lost hundreds of volunteers, many of whom were killed by the regime and its allies in “double-tap” bombings, whereby the site of a bombing is targeted twice in close succession in order to harm first responders. 

The NGO Physicians for Human Rights documented 540 attacks against healthcare facilities and the murders of at least 827 medical staff committed by the Syrian government and its allies between March 2011 and March 2021. 

At the same time, the regime has clearly demonstrated mismanagement in the ongoing COVID-19 pandemic, concealing its caseload and delaying the delivery of the vaccine outside regime-held areas. The lack of medical supplies and barriers to healthcare pushed many Syrians to seek treatment on the parallel market rather than in underserved and understaffed public hospitals.

In light of this harrowing track record, many wonder how the WHO allowed Syria to earn a seat on its top executive body and whether this disheartening diplomatic fiasco can be overturned.

What is the WHO’s Executive Board?

The WHO is made up of three bodies: the World Health Assembly, the Executive Board and the Secretariat.

Any internationally recognized state can become a member of the WHO and attend its yearly World Health Assembly. In addition, member states collaborate closely on regional health issues through membership in one of six regional offices. 

Syria is a member of the Eastern Mediterranean Regional Office (WHO EMRO), comprising 21 member states in addition to the Occupied Palestinian Territory. The EMRO currently has five members on the Executive Board, two of which were elected this year (Syria and Afghanistan).

Each year, the Health Assembly elects a dozen states to renew one-third of the 34 seats on its Executive Board. The elected states then nominate their representatives, which must be “technically qualified” individuals (typically Health Ministers or high civil servants). 

Among other executive tasks, the Board prepares the agenda of yearly assemblies. It can also submit proposals to the assembly, convene special conferences and “take emergency measures within the functions and financial resources of the Organization to deal with events requiring immediate action” (Article 28 of the WHO Constitution). The Board also has authority over a special fund established for emergencies (Article 58).

The remaining body, the Secretariat, can be likened to the WHO’s administration, where permanent staff work to implement the WHO’s decisions and its day-to-day work and programs.

How are member states elected to the Board? 

The procedures for the election of Board members are laid out in the WHO Constitution. According to Article 24, “the Health Assembly, taking into account an equitable geographical distribution, shall elect the Members entitled to designate a person to serve on the Board, provided that, of such Members, not less than three shall be elected from each of the regional organizations.” 

For example, the seats allocated to the Eastern Mediterranean can only be filled by one of the 21 WHO EMRO member states, with rotations encouraged. Syria, which already occupied a prominent position as vice-Chair of WHO EMRO in 2020, was a natural candidate for its regional group.

In practice, the Board is elected by consensus. To achieve this, the list of candidates is negotiated within and among the various regional blocks ahead of the Health Assembly. It relies heavily on a rotational system, ensuring that each state gets its turn and that the elections are not blocked by individual objections.

What does this mean for Syria and the WHO?

Syria’s election to the Executive Board aligns well with the regime’s efforts to normalize its international position. Syria’s representative is its Minister of Health, Dr. Hassan Muhammad al-Ghabbash, who has been on the UK and EU sanctions lists since 2020.

This symbolic victory for the regime comes only a month after a symbolic defeat (qualified by some as a ‘slap on the wrist’) at the Organisation for the Prohibition of Chemical Weapons (OPCW), which stripped Syria of its voting rights to sanction its continued use of chemical weapons.

Many observers have called for the WHO to adopt a similar sanction, which is possible under Article 7 of the WHO Constitution. However, member states are unlikely to consider such a move, which could have a devastating impact on WHO’s relationship with Syria and its ability to continue programs in the country, meager and patchy as the results may be.

Nevertheless, Syria’s election to the Executive Board has provoked uproar and further undermined the credibility of the WHO among many of its health and civil society partners in Syria. 

The WHO’s image, and that of other UN agencies, is increasingly damaged by their perceived weakness vis-à-vis the regime, which tightly controls the provision of aid and tries to feed off the humanitarian ecosystem in the country. This conflation is only likely to grow following the Board election, widely interpreted locally as a nod of approval to the regime.