Did the World Health Organisation contribute to Syria's polio outbreak?

WHO's response to Syria's polio outbreak, and its close relationship with the Syrian government, have been called into question.

A New York Times report has highlighted the failures that contributed to Syria’s polio outbreak, and suggested that “the United Nations itself has aggravated the situation”. The authors, Adam P Coutts, a researcher at the London School of Hygiene and Tropical Medicine, and Fouad M Fouad, a Syrian doctor, suggested that the World Health Organisation’s (WHO) close links with the Syrian government could have contributed to its failure to vaccinate children in the Deir al-Zour area – where cases of polio were detected last year. WHO is housed in the Syrian health ministry building, and some of its staff members are ex-government.

The New York Times reports that WHO argued that Deir al-Zour was not included in their 2012 vaccination campaign because “the majority of its residents have relocated to other areas of the country”, but says there is no evidence that this is true. In fact, the UN World Food Programme continued delivering food aid to Deir al-Zour until 2013.

Once polio had broken out, WHO was also slow to respond. The authors found it took three months for the first cases of polio to be confirmed after they were detected in July 2013. It then took several weeks for a vaccination programme to begin. These delays increase the risk of polio spreading, particularly as it’s not clear how the vaccination programme will cover the hundreds of thousands of Syrian refugees in Lebanon.

There is no doubt that the WHO is operating under extremely challenging circumstances. It is trying to implement an immunisation programme in an active warzone, and among refugees spread over vast distances. It is easy to see why it is struggling to contain polio. Like most UN agencies, WHO is often accused of being an unwieldy bureaucracy that can be slow to react, so this isn’t unique to Syria.

But then, this is also not the first time in recent memory that the UN has been accused of contributing to a public health scandal. If you haven’t read this report on how the UN inadvertently caused a cholera epidemic in Haiti and then covered it up, you should. It’s little wonder WHO and other UN agencies’ credibility is in question.

The incident also exposes shortcomings in how UN agencies operate. The UN’s humanitarian and development organisations work in partnership with their host countries and in wealthier developing countries they will be part or fully funded by their host government. There are strong arguments for working in this way: the long-term aim is to strengthen government departments so that with time they no longer need the UN’s expertise. UN agencies don’t want to impose their decisions and values on the countries they work in; instead they want governments to fully embrace goals like reducing maternal mortality or increasing school enrolment or protecting national heritage sites. In some countries, UN agencies are able to operate where other NGOs can’t, precisely because of this close partnership. But there are downsides.

For 18 months from 2008, I worked for the United Nations Development Programme in Libya. The vast majority of UNDP Libya’s funding came from the Libyan government, then headed by the country’s longstanding dictator, Muammar Gaddafi. UNDP Libya did it’s best to promote ideas like better women’s rights, improved environmental protection and poverty reduction in Libya, but it couldn’t ever do anything the government didn’t agree too. The Libyan government didn’t agree to much. At times, UNDP Libya tried too hard to ingratiate itself with its government funders: it appointed Aisha Gaddafi, Gaddafi’s daughter, as a local UN Goodwill Ambassador, for instance.

In countries like pre-revolutionary Libya, the UN has to strike a difficult political balance. In Syria, this balance is even harder to maintain. It’s no surprise that WHO in Syria would come under considerable pressure from the Syrian government, and that the Syrian government could easily limit what WHO is able to do in the country. It is also likely that WHO’s close relationship with the government is the reason it’s still able to operate in Syria - and ordinary Syrians would be much worse off without any WHO presence in the country. But in excluding Deir al-Zour from its vaccination programme, WHO has made a tragic misjudgement.

A Syrian child gets a polio vaccination at a clinic in Damascus on November 20, 2013. Photo: Getty.

Sophie McBain is a freelance writer based in Cairo. She was previously an assistant editor at the New Statesman.

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A loyalist rebranded: will Ségolène Royal run again to be the French President?

The French press is speculating about Ségolène Royal replacing François Hollande as the Socialist candidate.

“I will lead you to other victories!” Ségolène Royal told the crowds gathered in front of the French Socialist party’s headquarters on 6 May 2007.

Many at the time mocked her for making such an odd statement, just after losing to Nicolas Sarkozy in the presidential election. But nearly ten years on, she might just be the candidate the French left needs to win the upcoming presidential election.

There is growing speculation that the current President François Hollande – who was Royal’s partner for 30 years and the father of her four children – will not be in a position to run again. His approval ratings are so low that a defeat in next May’s election is almost inevitable. His own party is starting to turn against him and he can now only count on a handful of faithful supporters.

Royal is among them. In the past, she probably would have jumped at the opportunity to stand for election again, but she has learned from her mistakes. The 63-year-old has very cleverly rebranded herself as a wise, hard-working leader, while retaining the popular touch and strong-willed character which led to her previous successes.

Royal has an impressive political CV. She became an MP in 1988 and was on several occasions appointed to ministerial positions in the 1990s. In 2004, she was elected President of the Poitou-Charentes region in western France. In 2006, Royal won the Socialist party’s primary by a landslide ahead of the presidential election.

She went on to fight a tough campaign against Sarkozy, with little support from high-ranking members of her party. She ended up losing but was the first woman to ever go through to the second round of a French presidential election.

After that, it all went downhill. She split up with Hollande and lost the election to be party leader in 2008. She was humiliated by only getting 6.95 per cent of the votes in the 2011 Socialist presidential primary. She hit an all-time low when in 2012 she stood as the Socialist party’s official candidate to become MP for La Rochelle on the French west coast and lost to Olivier Falorni, a local candidate and Socialist party “dissident”. Royal then took a step back, away from the Parisian hustle and bustle. She continued to serve as the Poitou-Charentes regional President but kept largely out of the media eye.

Royal was very much the people’s candidate back in 2007. She drew her legitimacy from the primary result, which confirmed her huge popularity in opinion polls. She innovated by holding meetings where she would spend hours listening to people to build a collaborative manifesto: it was what she called participatory democracy. She shocked historical party figures by having La Marseillaise sung at campaign rallies and Tricolores flying; a tradition up until then reserved for right-wing rallies. She thought she would win the presidency because the people wanted her to, and did not take enough notice of those within her own party plotting her defeat.

Since then, Royal has cleverly rebranded herself – unlike Sarkozy, who has so far failed to convince the French he has changed.

When two years ago she was appointed environment minister, one of the highest-ranking cabinet positions, she kept her head down and worked hard to get an important bill on “energy transition” through Parliament. She can also be credited with the recent success of the Paris Climate Agreement.

Above all, she has been impeccably loyal to the President.

Royal has reinforced her political aura, by appearing at Hollande’s side for state occasions, to the extent that French press have even labelled her “the Vice-President”. This has given her a licence to openly contradict the Prime Minister Manuel Valls on various environmental issues, always cleverly placing herself on virtue’s side. In doing so, not only has she gained excellent approval ratings but she has pleased the Green party, a traditional ally for the Socialists that has recently turned its back on Hollande.

The hard work seems to have paid off. Last Sunday, Le Journal du Dimanche’s front-page story was on Royal and the hypothesis that she might stand if Hollande does not. She has dismissed the speculations, saying she found them amusing.

Whatever she is really thinking or planning, she has learned from past errors and knows that the French do not want leaders who appear to be primarily concerned with their own political fate. She warned last Sunday that, “for now, François Hollande is the candidate”. For now.

Philip Kyle is a French and English freelance journalist.