I am writing this letter from the perspective of one of Public Health Research & Practice journal’s Associate Editors, to put forward my views on the geopoliticisation of healthcare. My decision to write this letter was stimulated by the publication of a 2021 Supplementary Issue of the journal that examined politics and political determinants of health policy and systems research globally.1 The issue was sponsored by the World Health Organization (WHO) Alliance for Health Policy and Systems Research and included an article on funding for health policy and systems research in the WHO Eastern Mediterranean region.2 While I do not take issue with the paper, the WHO’s work in this region of the world is, I believe, highly politicised.
While geopolitics has no place in healthcare, healthcare it seems, continues to be geopoliticised. A clear example is the WHO’s stance on the Middle East region and countries, overseen by its Regional Office for the Eastern Mediterranean. These countries include: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, State of Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen.3
Firstly Israel, despite its geographical location, is clearly absent from the list while included, seemingly illogically, in the WHO European Region. Secondly, along with The Institute for Middle East Understanding4 and the United Nations Office for the Coordination of Humanitarian Affairs5, the WHO describes Palestine as “Occupied Palestinian Territory”, (including the West Bank and the Gaza Strip). Thirdly, healthcare services in the region are underpinned by a Unified Arabic-English-French Medical Dictionary.6 The aim of this publication – to help advance medicine and health related sciences in Arabic countries – while admirable, is patently exclusive (Hebrew is evidently excluded from this dictionary, while it is the major spoken and written language in Israel).
The WHO’s definition and aim, the omission of Israel despite its centrality in the Middle East region, and the naming of Palestine as an “Occupied Territory” sets a dangerous precedent – namely the normalisation of geopolitics in international affairs, including healthcare, spearheaded by one of the major governing bodies responsible for its oversight worldwide.
The WHO’s current statement on its website Health Cluster describes: “decades-long occupation of Palestinian territory and its violence and destruction”.7 This statement leads me to conclude that a unique opportunity for creating links between countries and presenting a more wide-ranging and balanced view, in the name of better health and wellbeing for all, has been tragically missed.
I wish to conclude on a positive note. The Editor-in-Chief, with the approval of the full Editorial Board, offered me the opportunity to present my case in this letter and took my concerns extremely seriously.
FR is a Board Member and Associate Editor of Public Health Research & Practice. The views expressed in this letter are her own.
Frances Rapport | Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
Corresponding author: [email protected]
Dr Abdul Ghaffar, Guest Editor PHRP 2021, Vol. 31(4)1; Executive Director, Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.
Thank you for the opportunity to comment on this letter. I understand that the Editor-in-Chief made the decision to publish this letter. I respect the decision, but would like to clarify a number of points and provide context for the position taken in this letter:
Firstly, it is important to clarify that Israel, Cyprus and Algeria were all originally part of the WHO Eastern Mediterranean Regional Office (EMRO) but later Israel and Cyprus decided to move to the European Region (EURO), and Algeria decided to move to the African Region (AFRO). The decision was made by the Member States themselves not by EMRO.
Secondly, in accordance with relevant World Health Assembly resolutions and well-established practice the term “Palestine” is used to refer to the “Observer” that participates in the Health Assembly, Executive Board and their committees, as well as to the “Member” in the WHO Regional Committee for the Eastern Mediterranean region. In WHO materials, the Secretariat uses the expression “occupied Palestinian territory, including east Jerusalem” to refer to the territory in question (i.e. not the Observer). The WHO Secretariat is obliged to follow the decisions of the Member States in public documents, including the paper published in the special edition of Public Health Research and Practice.
I hope these facts provide some context for the issues raised by Professor Rapport’s letter.
1. Public Health Research & Practice. Strengthening health systems globally: a lingering challenge of funding. Sydney: PHRP; Nov 2021 [cited 2022 Apr 27]. Available from:
2. Rabbat ME, El-Jardali F, Fadlallah R, Soror S, Ahmadnezhad E, Badr E, Dabis J Funding for health policy and systems research in the Eastern Mediterranean region: amount, source and key determinants.2021;31(4):e3142119.
3. World Health Organization. Regional Office for the Eastern Mediterranean. Geneva: WHO; 2022 [cited 2022 Apr 27]. Available from: www.emro.who.int/countries.html
4. The Institute for Middle East Understanding. What are the Occupied Territories? California, US: IMEU; 2005 [cited 2022 Mar 25]. Available from: imeu.org/article/what-are-the-occupied-territories?
5. United Nations Office for the Coordination of Humanitarian Affairs. Humanitarian Response Plan (HRP) 2021. East Jerusalem: OCHA; 2021 [cited 2022 Mar 25]. Available from: www.ochaopt.org/content/humanitarian-response-plan-2021
6. World Health Organization. The unified medical dictionary: English-French-Arabic. Geneva: Regional Office for the Eastern Mediterranean & Libraries due Liban Publishers; 2009 [cited 2022 Apr 22].Available from: apps.who.int/iris/handle/10665/119895
7. Health Cluster. Occupied Palestinian Territory. Geneva: WHO: 2022 [cited 2022, Mar 25]. Available from: healthcluster.who.int/countries-and-regions/occupied-palestinian-territory