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.