Medical armored personnel carrier. Medical cross on the armor of an armored vehicle against the background of the flag of Ukraine at exhibition ARMS AND SECURITY - 2021. Kiev. Ukraine - June 18, 2021.

Sutures for Ukraine: The Medical Case for City Diplomacy

By Vrushab Gowda, Leslie Appleton, and Jesse Ehrenfeld

The war in Ukraine has brought nothing less than an unmitigated humanitarian catastrophe. Health care infrastructure has been deliberately — and systematically — targeted by Russian forces since the very outset of the invasion. Hospitals have been bombed, internal displacement has uprooted providers from their communities, and rail lines have come under sustained bombardment from cruise missiles, hindering the resupply of frontline towns. All of this has exacerbated the demands on an already fragile health care system, which strains to keep up. The Ukrainian people urgently need practical solutions.

Enter city diplomacy. In parallel to official channels of federal aid, American cities can play a decisive role in supporting their Ukrainian counterparts under threat. An “Adopt-a-City” campaign could leverage preexisting ties within a sister cities context (like Los Angeles and Kiev, if approved), which can be bolstered and intensified. Where these relationships do not exist, they can be created. New York could “adopt” Odessa. Atlanta, Kharkiv. Houston, Dnipro.

City departments of health would take center stage throughout all of this. Unlike howitzers, ammunition, electrical grids, and water supplies, medical aid is readily portable across international lines and can be concentrated in urban settings. An “Adopt-a-City” platform would provide a unified vehicle for channeling it, permitting American cities to render material and infrastructural assistance alike.

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Lima, Peru - March 8 2019: Group of Peruvian woman supporting the movement girls not mothers (niñas, no madres). A social campaign for abortion rights for underaged raped girls.

Grassroots Mobilization Needed to Defend Abortion Access

By Camila Gianella

On August 3, Kansas voters spurned the recent decision in Dobbs v. Jackson Women’s Health Organization by rejecting a proposed constitutional amendment that, in line with the ruling, aimed to ban abortion in the state.

What happened in Kansas shows the central role of social and political mobilization in securing abortion rights. In Kansas, Dobbs caused an unprecedented mobilization of women voters.

On the other hand, without such mobilization, access to abortion can suffer – even if the law protects sexual and reproductive health and rights (SRHR). In the case of Peru, my country, which is often cited as an example of the internationalization of SRHR norms through supranational litigation, internationally recognized legal victories have often fallen short of the high expectations they created. Despite the success of international bodies, abortion rights in Peru have not been expanded. Further, there are attempts at the legislative level to advance a total ban on abortion.

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KYIV, UKRAINE - Feb. 25, 2022: War of Russia against Ukraine. A residential building damaged by an enemy aircraft in the Ukrainian capital Kyiv.

Misplaced Skepticism on Accountability for War Crimes Against Health Care in Ukraine

By Leonard Rubenstein

Russian attacks on hospitals, ambulances, and health workers in Ukraine — including more than 180 attacks confirmed by the World Health Organization, and double that number reported by the Ministry of Health — have gained global attention. In one case, viral photos document the evacuation of pregnant women, including one on a stretcher who later died, from a maternity hospital in Mariupol destroyed by Russian shelling. It is likely that investigations will show that many of these acts are war crimes. Accountability for these crimes must be pursued.

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Sign at train station in Berlin that describes free support for pet owners coming from Ukraine.

Ethical Challenges Associated with the Protection of Pets in War

(Photo: Sign at the central train station in Berlin (Berlin Hauptbahnhof) that offers free support for pet owners coming from Ukraine. Courtesy of Kristin Sandvik.)

By Kristin Bergtora Sandvik

Introduction

The care for animals rapidly became a part of the humanitarian narrative of the attack on Ukraine.

There are countless accounts of the efforts of activists, shelters and zoo staff to keep animals alive, as well as underground operations to get them to safety. And, as Ukrainians flee for their lives, they are frequently accompanied by their pets.

EU initiatives and advocacy efforts by animal rights groups pushed receiving countries to modify entrance requirements, waive fees, provide veterinary services, and shorten or eliminate quarantine times. The EU announced a special derogation in Regulation 2013/576, allowing the import of Ukrainian refugee pets without meeting standard requirements. Many governments have welcomed Ukrainian pets with or without their owners, and without documentation, rabies vaccine, and/or microchip.

Humanitarian action is typically human centric; this broad societal acceptance of pets as legitimate refugee companions, and the attendant rapid regulatory accommodations, are unique developments. In this blog, I draw on perspectives from disaster studies, international humanitarian law (IHL), refugee studies, and animal studies to articulate a set of ethical dilemmas around classification and policymaking that arise when pets are recognized as a humanitarian protection problem.

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Traffic light.

The COVID-19 Pandemic, the Failure of the Binary PHEIC Declaration System, and the Need for Reform

This post was originally published on the Verfassungsblog as part of our joint symposium on international pandemic lawmaking.

By Ilja Richard Pavone

The COVID-19 pandemic has raised unprecedented challenges for the global health framework and its long-term consequences are not yet in full sight. The legal and institutional regime aimed at preventing and controlling the spread of infectious diseases, grounded on the International Health Regulations (IHR) was heavily criticized.

The alarm mechanism based on the declaration of Public Health Emergency of International Concern (PHEIC), in particular, has been severely tested. A PHEIC is an extraordinary event that constitutes a potential public health risk through the international spread of a disease outbreak. The WHO Director-General bases his decision to “ring the bell” upon the technical advice of an Emergency Committee (EC) carrying out “an assessment of the risk to human health, of the risk of international spread, and of the risk of interference with international traffic.”

A PHEIC, then, is declared only when an event is already sufficiently acute and has started to spread internationally. It is not an early warning, but a formal alert, and in the case of COVID-19 it was issued with extreme delay only on 30 January 2020, (one month after notification of early cases by the Chinese government), after Beijing had already adopted quarantine measures around the city of Wuhan, and draconian measures to curb the spread of the disease in the country had been announced.

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The Mexican-American border, with some construction still ongoing on the American side.

Pandemics without Borders? Reconsidering Territoriality in Pandemic Preparedness and Response Instruments

This post was originally published on the Verfassungsblog as part of our joint symposium on international pandemic lawmaking.

By Raphael Oidtmann

The COVID-19 pandemic has (yet again) disclosed that, in contemporary international law, the notion of borders resembles a distinct emanation of legal fiction, i.e., “something assumed in law to be fact irrespective of the truth or accuracy of that assumption.” This characterization of international borders holds particularly true with a view towards managing, containing, and countering the spread of highly contagious pathogens: especially in the context of responding to the global COVID-19 pandemic, it has hence become apparent that the traditional conception of borders as physical frontiers has been rendered somewhat moot. On the contrary, the pandemic experience has proven that a more flexible, fluid, and functional understanding of (international) borders might be warranted, also with a view towards (re-)conceptualizing international health law.

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Society or population, social diversity. Flat cartoon vector illustration.

The Right to Participation in Global Health Governance: Lessons Learned

This post was originally published on the Verfassungsblog as part of our joint symposium on international pandemic lawmaking.

By Sara (Meg) Davis, Mike Podmore, and Courtenay Howe

What should the role of those most affected by pandemics be in future pandemic governance and co-ordination mechanisms?

Drawing on human rights standards and principles, and on existing structures in the HIV, TB and malaria sectors, we argue that the human right to participation should extend to permanent seats and votes for civil society and affected communities on governance boards.* Our argument is informed by an analysis by STOPAIDS, Aidsfonds, CSSN and Frontline AIDS, by consultations led by STOPAIDS, and by the examples of the Global Fund to Fight AIDS, TB and Malaria (“the Global Fund”), Unitaid, and the Access to Covid Technologies-Accelerator (ACT-A).

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Scales of justice and gavel on table.

Limiting Human Rights During Pandemics: Recommendations for Closing Reporting Gaps and Increasing International Oversight

This post was originally published on the Verfassungsblog as part of our joint symposium on international pandemic lawmaking.

By Cassandra Emmons

Sovereign governments have the prerogative to declare states of emergency when sudden, unanticipated events threaten the lives of the nation and its people. In so doing, government decrees sometimes must contradict other international human rights commitments, balancing the individual versus the collective. Established derogation procedures are supposed to ensure such restrictions are proportionate, non-discriminatory, and last only as long as necessary (for an overview, see Emmons 2020). COVID-19 has proven that public health emergencies are not equally recognized in either international law or national constitutions; some international treaties permit “limiting” rights in the name of public health rather than requiring derogation, and nationally some governments authorize emergency measures in practice without ever doing so in name. These parallel processes and conceptual gaps create space for governments to restrict individuals’ rights with little to no international accountability during pandemics.

In this piece, I recommend a new international instrument on pandemic response be explicit about reporting requirements when governments suspend rights during such emergencies. These suggestions incorporate advice from the American Association for the International Commission of Jurists’ Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights (1985), the International Law Association’s Queensland Guidelines for Bodies Monitoring Respect for Human Rights during States of Emergency (1990), case law of the European Court of Human Rights (ECtHR), and learned experience from the COVID-19 pandemic.

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Globe.

Killing Locally or Killing Globally? Inequalities in Framing Cooperation Through Pandemics

This post was originally published on the Verfassungsblog as part of our joint symposium on international pandemic lawmaking.

By Luciano Bottini Filho

COVID-19 made “pandemic” a buzzword. The world expressed anxiety on the eve of a pandemic declaration from the WHO, a decision monitored as closely as the white smoke for a newly elected pope. Yet, “pandemic” has no legal value in international law by contrast with a declaration of public health emergency of international concern (PHEIC). It is no accident that the 12th Commission of the Institute of International Law issued a report on Epidemics and International Law, which bluntly avoided the term pandemic.

Despite this, for the general public, the role of a PHEIC determination remains unknown. Given the inconsistency in declaring PHEIC (only 6 events between 2007 and 2020), many epidemics of considerable proportion were ignored by the international community. Yet the mismatch in the general public consciousness regarding the legal implications triggered by a WHO declaration of a PHEIC is not as problematic as the way lawyers and public health practitioners reinforce the centrality of a pandemic, a concept that still requires a more solid definition.

As an international instrument potentially moves forward to galvanize “pandemics” as a legally defined term — and part of global health governance — we must understand the implication that this word has in relation to disparities between developing countries‘ problems and the interests of their richer counterparts. After all, any pandemic would have originated from one or more national epidemics, but it would require a globally recognized procedure to trigger stronger international obligations. As opposed to pandemics, though, epidemics have persisted for decades and raged in low- and low-middle income settings from Zika to Ebola, demanding support from international actors.

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Globalization concept illustration.

Human Rights and Global Responses to the Pandemic in the Age of Hyper-globalization

This post was originally published on the Verfassungsblog as part of our joint symposium on international pandemic lawmaking.

By Sakiko Fukuda-Parr

In 1999, the Human Development Report called for stronger international arrangements to govern people in a globalized world, stating: “the present era of globalization, driven by competitive global markets, is outpacing the governance of markets and the repercussions on people…. An essential aspect of global governance is responsibility to people – to equity, to justice, and to enlarging the choices of all.” As the 21st century sped into an era of hyper-globalization, new global institutions are urgently needed to protect the public interest. The architecture of global health emergencies is a case in point. Its core agreement, the International Health Regulations (2005) (IHR) remains state centric, catering to national interests, bound to colonial epistemic frameworks, and silent on market power that can trample on human rights. The age of hyper-globalization requires global institutions that enable global – collective – responses to contain pandemics worldwide, that build on international solidarity and human rights norms, and structures that break free from North-South hierarchies of power and knowledge.

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