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WHO: Tedros Adhanom raised eyebrows with his appointment of Robert Mugabe and new recruitment policies. But the real shocker was his choice of a Russian to head up agency’s tuberculosis fight. January 17, 2018

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The Mugabe appointment “was stupid, but this is a disaster,” said Mark Harrington, executive director of Treatment Action Group. Ahead of the appointment, TAG led an open letter from more than 40 civil society groups asking Tedros to use a transparent, competitive process to choose the next director of the Global TB Program, tasked with fighting the top infectious killer worldwide.

 #NoTedros4WHO

World’s doctor gives WHO a headache


Tedros Adhanom Ghebreyesus raised eyebrows with his appointment of Robert Mugabe and new recruitment policies. But the real shocker was his choice of a Russian to head up agency’s tuberculosis fight.

 

Illustration by Eva Bee for POLITICO

 

Seven months into his tenure, the early moves of the WHO’s first African chief are stoking a backlash.

His supporters say Tedros Adhanom Ghebreyesus promised to shake the institution up. The critics, increasingly emboldened, say he’s undermining the World Health Organization’s effectiveness and putting its funding at risk.

The former Ethiopian health minister turned heads with his appointment of Zimbabwean dictator Robert Mugabe as a goodwill ambassador in October. Meanwhile, behind the scenes, Tedros — as he prefers to be called by Ethiopian tradition — was eschewing the normal hiring process for U.N. agencies, looking to increase gender and geographical diversity as quickly as possible. That’s unsettled some in the Geneva headquarters and the constellation of activists and researchers who work with WHO, who fear an overly political approach is bringing a culture change at the cost of credibility.

The latest disruptive move is his appointment of a little-known Russian official to run the WHO’s tuberculosis program, using a fast-track process, one month after meeting with President Vladimir Putin at a major gathering on the topic in Moscow.

The Mugabe appointment “was stupid, but this is a disaster,” said Mark Harrington, executive director of Treatment Action Group. Ahead of the appointment, TAG led an open letter from more than 40 civil society groups asking Tedros to use a transparent, competitive process to choose the next director of the Global TB Program, tasked with fighting the top infectious killer worldwide.

Reward for being retrograde

The December nomination of Tereza Kasaeva (an official at the Russian health ministry) prompted an editorial in the medical journal the Lancet, which described it as triggering a “potentially disabling controversy.”

“The domestic situation there is horrible. It’s probably one of the worst outside of Africa on TB infections” — Eduardo Gómez, King’s College London

“Russia has a poor record on TB and HIV,” write the editors of the journal, which is widely seen as the voice of the global health establishment. “Her appointment may be regarded as rewarding a country that does not deserve to be rewarded … WHO’s reputation — indeed, its political leverage — depends on the agency’s technical credibility.”

Russia is widely regarded as retrograde in its approach to treating the infectious disease, having developed a raging outbreak after the breakdown of the Soviet Union. Since 2000 or so, overall incidences are down and survival rates are up, but Russia is still a world leader on the proportion of infections that don’t respond to antibiotics; a recent study predicted one in three cases would be antibiotic resistant by 2040.

Kasaeva replaces Mario Raviglione, a leading TB expert with more than 25 years of experience fighting the bacterial infection.

Tedros says he’s just keeping a campaign promise to overhaul the agency in the wake of its high-profile failure to respond quickly to the 2014 Ebola crisis in West Africa. He is the first African to run the WHO — and the first director general chosen with a vote open to all member countries in May, overcoming what he called a “colonial mindset” among backers of his British rival.

Tedros’ advisers have defended his decision to name Mugabe a goodwill ambassador for noncommunicable diseases less than four months into the job as just a misguided effort to build bridges with a regional giant who, despite human rights violations and a long embrace of the tobacco industry, recently expressed openness to new commitments on health.

The offer was quickly retracted, but not before it triggered international condemnation. An opinion piece in the Washington Post even speculated that it was payback to Mugabe for securing the African Union’s support in the WHO election, or to China for its backing.

Tedros’ first appointments have already transformed the gender and geographic balance within the top ranks, even as they have raised concerns about a closed selection that downplays conventional expertise.

Of eight new directors chosen largely through a fast-track process, including Kasaeva, all but one are women.

Tedros is trying change the recruitment system to eliminate “unconscious biases that make it unfavorable for women to get the positions,” a top Tedros adviser, Senait Fisseha, said in an email. Until that can be accomplished, she said, he had made “limited appointments of diverse and highly qualified women” to move his vision forward.

That’s music to the ears of those who see an endless game of musical chairs that circulates people from one U.N. or international development agency to another. Often that means wealthy Western countries dictating to poorer countries how to deal with their problems in order to receive aid.

Vlad in Geneva

Diversity is a worthy goal, said Global Coalition of TB Activists CEO Blessina Kumar. But it shouldn’t come “at the cost of effectiveness and competency. You can’t trade one for the other,” she said.

“Merit was the first criteria for all appointments, while secondary consideration was given to gender and geographical diversity,” WHO spokesman Gregory Hartl said. “Dr. Tedros also sought to appoint qualified people with country-level experience, as a vital complement to the technical expertise that already exists within WHO. This will help to accelerate progress at the country level.”

Kasaeva’s appointment has proved politically volatile both for Russia’s speckled track record in combatting TB, and because it’s seen as playing into Putin’s hands, helping the Russian president project power on the global health stage while he neglects patients back home.

“The domestic situation there is horrible. It’s probably one of the worst outside of Africa on TB infections,” said King’s College London’s Eduardo Gómez, the author of “Geopolitics in Health: Confronting Obesity, AIDS, and Tuberculosis in the Emerging BRICS Economies.”

In 2012, Russia rejected a $127 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, stifling many of the groups on the ground. On top of that, the federal government cut domestic TB funding in recent years, according to Gómez.

Nonetheless, in mid-November, Russia pledged $15 million toward fighting TB worldwide during a major U.N. TB conference in Moscow. The foreign aid is a typical Putin move, said Gomez. “This is an opportunity to reassert Russia’s dominance in global health.”

Putin addressed the gathering and met with Tedros. A month later, on December 15, Tedros announced Kasaeva’s appointment in an internal WHO email.

“I can’t see what the upside is other than political payback,” Harrington said.

Backlash on Tedros

Defenders say Russia’s TB program is improving — driven in part by Kasaeva — and that she may be the best hope for getting the country to change.

Vadim Testov, a former WHO official now working on Russia’s TB program, said he’s seen the government’s commitment increase over time, and that it’s “ready to provide” financing to make Russia’s domestic TB fight successful. He noted that new regulations from Kasaeva’s team have led to a sharper decrease in TB cases over the last five years.

Kasaeva “will have influence on Russian officials” in her WHO position, Testov predicted.

Many aren’t sold on Tedros’ new approach and fear that global health will suffer — especially if the WHO’s biggest donors get spooked.

The backlash shows the risks from Tedros’ effort to upend the status quo. Defenders say the same-old same-old at the U.N. hasn’t served patients on Ebola, TB or a range of other issues.

“Whatever we’ve been doing for the last quarter century isn’t working that well,” said Salmaan Keshavjee, a Harvard TB expert who has worked on the ground in Russia with Partners in Health.

He argued that WHO recommendations have in the past been ill-suited to Russia’s circumstances and that homegrown experts from emerging, populous economies may be in a better position to solve their own problems and bring a new perspective to the global effort.

“If you want to hold the BRICS countries’ feet to the fire, they have to be involved in health architecture,” Keshavjee said.

Budget strings

But many aren’t sold on Tedros’ new approach and fear that global health will suffer — especially if the WHO’s biggest donors get spooked.

Though ultimately blocked, U.S. President Donald Trump’s proposal to cut back on foreign aid — announced on May 23, the same day Tedros was elected to lead the WHO — has alarmed many in the organization. The recent controversies drive some worry that other large donors like the U.K. or Germany might be tempted to draw the purse strings tighter.

The U.S. contributes almost a quarter of the WHO’s $4 billion-plus annual budget.

Tedros’ doctorate is in community health, and he served as Ethiopia’s health minister for seven years — winning wide praise for strides in expanding contraception, fighting malaria and, yes, controlling TB.

But it may be his experience as Ethiopia’s top diplomat from 2012 to 2016 that seems most apposite now. During that period, he kept his country in the West’s good graces (and the aid money flowing) despite growing concerns about the regime’s human rights violations, by stressing Ethiopia’s position as a stable, strategic partner in the war on terror.

Tedros’ team includes plenty of conventional choices; Jane Ellison, a Brit, served as something of an olive branch to the WHO’s No. 2 state donor after the U.K. strongly backed its own candidate in a campaign that turned nasty. Tedros also named a German to a long-sought top post after Berlin stepped up donations and raised Tedros’ profile by inviting him to the G20 summit.

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World Health Organization (WHO): Call for the resignation of Tedros Adhanom, WHO Director General, petition launched October 28, 2017

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Call for the resignation of Tedros Adhanom Ghebreyesus, WHO Director General

Your recent decision to nominate Mr. Mugabe disqualifies you entirely, totally, completely and unequivocally to hold the respected role of General Director of WHO. You should resign.You have lost all credibility and authority needed to lead WHO and you have brought disgrace to this honourable organisation. You should resign.If you do not want to resign we will launch a worldwide petition to ask our governments to revoke your mandate.

https://www.change.org/p/who-call-for-resignation-of-tedros-adhanom-ghebreyesus-who-director-general

Stat News: How a blunder over Robert Mugabe has cost the WHO goodwill it needs

Stat News: How a blunder over Robert Mugabe has cost the WHO goodwill it needs October 25, 2017

Posted by OromianEconomist in Human Rights, Uncategorized, WHO.
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The global health community is struggling to make sense of a blunder that has shaken confidence in the new director-general of the World Health Organization and given rise to concerns — both outside and within the WHO — about the impact the episode will have on the credibility of the agency he leads.

Mere days after hitting the 100-day mark of his first term in the office, Tedros Adhanom Ghebreyesus appointed Zimbabwean President Robert Mugabe to a ceremonial position of honor, naming the longtime authoritarian as a WHO goodwill ambassador for noncommunicable diseases.

Four days later, under intense international pressure, Tedros — who goes by his first name — withdrew the appointment.

“I have listened carefully to all who have expressed their concerns, and heard the different issues that they have raised,” he said in a statement issued Sunday.

There were sighs of relief and calls from some global health heavyweights to rally round a new leader who had the courage to publicly acknowledge a major mistake, and to swiftly correct it.

We have to allow leaders to admit mistakes listen reflect & when needed change decision.Brave leadership something we can all learn from.

But within the broad community of people who work with and for the WHO, the stunning incident has created a sense of deep unease about why Tedros made the sure-to-be-challenged appointment in the first place and how a man who had been Ethiopia’s foreign minister — his country’s top diplomat — for four years did not anticipate the firestorm the Mugabe appointment would ignite.

The episode has raised questions about the new director-general’s judgment and what damage this lapse could inflict on the WHO, which faces major challenges during his tenure. Criticism of the appointment came from a multitude of sources, including many of the countries that provide much of the WHO’s funding.

“I think some of the arguments for his candidacy were that he’d been both a health minister and a foreign minister, and merging the technical and diplomatic aspects should have been his strength,” noted Jimmy Kolker, a retired U.S. diplomat who served as assistant secretary for global affairs at the Department of Health and Human Services during the Obama administration.

“I think he fell down on both sides … and certainly he underestimated the political or diplomatic liability this would be for WHO.”

Tedros has not publicly explained why he thought the 93-year-old Mugabe — a leader who has clung to power for decades by suppressing political opposition and trampling human rights in his country — was the right person to task with promoting the fight against cancer and heart disease to other African nations.

Even if you put aside Mugabe’s political track record — and no critic of the appointment would willingly do so — he was an unusual choice as a champion in the fight against chronic diseases. Zimbabwe is Africa’s largest tobacco producer and exporter. And under Mugabe, its health system has been beggared; the president himself leaves the country when he needs care.

Tedros had initially agreed to speak with STAT about the issue, but declined on Sunday, saying he felt his statement was enough and he was busy with other issues. A spokesperson for his office reaffirmed Monday that he would not give interviews about the matter.

In the absence of insights into his thinking, observers are drawing conclusions. They don’t find them reassuring, even as they support the WHO and want the agency to become stronger under Tedros.

Some have questioned whether the move was an attempt by Tedros to reward those who supported him in the race for director-general. Though balloting during the May election was secret and there’s no way to be certain who voted for whom, the 55-member African Union had unanimously endorsed his candidacy.

The road to that endorsement was paved by a vote by the union’s executive council in January 2016, which came just as Mugabe ended a year’s term as the African Union’s chair. Mugabe chaired the meeting.

Tedros himself credited “the unity of Africa” for his victory in a speech to the WHO regional committee for Africa in Zimbabwe in late August — an event Mugabe attended. In the address Tedros heaped praise on Mugabe, noting his “strong commitment to health.”

David Fidler, professor of international health law at Indiana University, said there’s currently no evidence the ambassadorship was payback for the African Union’s endorsement. “But the appointment of Mugabe was so bizarre that this explanation has to remain on the table until DG Tedros and WHO explain … why and how the appointment was made,” he told STAT on Sunday in an email.

Kolker said there has been a tradition at the WHO of directors-general rewarding countries that supported their candidacies. (Tedros is the first WHO leader to be elected by all member states; previously the director-general was selected by the WHO’s executive board.)

Still, the international community had been looking to Tedros to change the way the WHO operates and to restore the agency’s credibility, damaged in recent years by a perceived over-response to the mild 2009 H1N1 flu pandemic, a tragically slow response to the 2014 Ebola outbreak in West Africa, as well as reports of questionable travel expenditures. Restoring the WHO’s credibility is key, observers say, to getting countries to increase the agency’s funding, which has not kept pace with inflation for at least the last decade.

“It’s disappointing, the misstep of falling into an old pattern of making this about political support and that kind of sort of payback for political support, to me is a worrying sign,” said Kolker, who went on to stress, though, that he and many others want Tedros to succeed as director-general.

“I don’t want to make it too much just about him but it does seem as though the mandate that he has to make WHO a different and better kind of organization will be hurt by this. Because it was a misstep and it misjudged, I think, what the rest of the world was looking to him to do.”

It is also being seen as a serious miscalculation by dismayed WHO staff, many of whom first learned about the appointment through news coverage.

Dr. Ashish Jha, director of the Harvard Global Health Institute, is among those who have publicly applauded Tedros for reversing the Mugabe appointment. But he worried the “terrible decision” will feed into a cynical narrative — that the WHO doesn’t really care about human rights or global health.

The agency has gone through a bruising time, and it seemed like the election of the new director-general was an opportunity to hit the reset button, Jha suggested. Tedros, who handily beat five competitors for the job, seemed to get off to a solid start, recently appointing a strong and diverse senior management team.

“He was building a lot of goodwill and I think there was a sense that maybe this was a turning of the chapter at WHO,” said Jha, who added the appointment of Mugabe had let the air out of the balloon.

So what happens now? The cautious optimism that was the prevailing mood among WHO supporters has been replaced with anxious concern. And how much pause will this miscalculation give member countries, the folks who write the checks? “I honestly don’t know,” said Kolker.

There will be a price, Fidler predicted. “After this debacle, the leadership of DG Tedros will be under intense scrutiny, meaning he has wasted goodwill and political capital in making such a terrible decision and then admitting it was a terrible decision.”

“This intense scrutiny, and the impact of it on his director-generalship, might alter the agenda DG Tedros intended to pursue in order to placate the many government and non-governmental critics of his Mugabe decision,” he said.

Meanwhile some critics have signaled the issue hasn’t yet been put to rest.

The U.N. watchdog organization U.N. Watch called for a full and independent inquiry into the episode, demanding to know “what deals were made?”

Though he didn’t call for a formal inquiry, Fidler said it will be important to explore what the event says about Tedros’s leadership style, to find out how the decision was made, and what steps were taken to help the agency respond to “the utterly foreseeable outcry about this decision.”


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QZ: BIRDS OF A FEATHER? It’s not so surprising WHO’s new director tried to make Robert Mugabe a goodwill ambassador

Video (Oromian Economist file)

 

Global Voices: As WHO Director-General Election Nears, Ethiopia’s Candidate Is Accused of Cholera Cover-Ups. #WHA70 May 16, 2017

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As WHO Director-General Election Nears, Ethiopia’s Candidate Is Accused of Cholera Cover-Ups

A Unicef-supported pump in Ethiopia. © UNICEF Ethiopia/2016/Ayene. CC BY-NC-ND 2.0.

In January 2017, when Ethiopia’s candidate for director-general of World Health Organization, Tedros Adahanom, stormed to the top of the final three candidates — beating out six other candidates — it was a high time for Ethiopia’s government.

Although Adahanom had faced ferocious opposition from his fellow citizens, he has largely made it through unscathed, giving a propaganda victory for Ethiopian state media. With his well-funded campaign, Adahanom has traveled to more than 120 countries, and his supporters felt confident that his election is all but a matter of time.

Then on May 13, the New York Times ran a story reporting that a “prominent global health expert” had accused Adahanom of concealing three cholera epidemics from 2008 to 2011 during his tenure as Ethiopia’s health minister. Lawrence O. Gostin made the allegations; he is an informal adviser to one of Adahanom’s opponents in the director-general race, the UK’s David Nabarro, but Nabarro told the New York Times that he had not instructed Gostin to make the accusations on his behalf.

Finally! The @NYTimes calls out @WHO DG candidate @DrTedros for covering up cholera epidemic using the euphemism of Acute Water Diarrhea. https://twitter.com/nytimes/status/863525012258656257 

Abebe Gellaw, a prominent Ethiopian journalist in the diaspora, wrote on Facebook that it was only the beginning:

New York Times has a hard-hitting article on Tedros Adhanom. Tedros says it is a “smear campaign”. But the revelation is just the tip of the iceberg. A lot more will come out in the next few days…

A screenshot of the New York Times article on Tedros Adahanom. Click the image to read the story on nytimes.com

The explosive article made Adahanom and his supporters defensive while it created a sense of vindication for his opponents. Adahanom has denied the allegations. A former Reuters journalist who wrote Ethiopia’s cholera outbreak in 2009, however, responded on Twitter that the accusations as detailed in the New York Times story was consistent with what he had seen.

In 2009, when Tedros was health minister, I obtained minutes of an NGO/UN meeting, in which a cholera outbreak was acknowledged.

NGOs, UN and government refused to comment. And UN officials pressured me not to run story. Full story here: http://reut.rs/2pLNcz5 

Photo published for Cholera/diarrhoea outbreak hits 18,000 in Ethiopia

Cholera/diarrhoea outbreak hits 18,000 in Ethiopia

Cholera and other diarrhoeal diseases have infected 18,000 people in Ethiopia over the last three weeks in many parts of the country, including the capital Addis Ababa, according to a document seen…

reuters.com

At the time, UN officials regularly complained in private that lack of acknowledgement from govt stopped them getting more aid in.

In responding to the allegations, Adahanom accused Nabarro’s camp of engaging in smear campaign with imperialistic intentions. Pro-government groups took this line of accusation even further, claiming Nabarro is working with Ethiopian opposition groups that are labeled as “terrorists.”

Ethiopia’s semi-official news outlet accuses the current special advisor to the UN Secretary General, Dr. David Navarro with terrorism.

😳 https://twitter.com/abbaacabsa/status/863805131342700545 

Since April 2014, a popular protest movement in Ethiopia has challenged the government, which in turn has responded brutally. According to Human Rights Watch, at least 800 people have died, and thousands of political opponents and hundreds of dissidents have been accused of terrorism. Since October 2016, authorities have imposed some of the world’s toughest censorship laws after it declared a state of emergency.

Now, the tactic of calling opponents “terrorists” has spilled over Ethiopia’s borders and might create blowback for Adahanom as his record is examined critically by international media.

The health ministers of WHO member states will vote for the new director-general on May 23, 2017.

WHO Director General Nominee Tedros Adhanom Represents Ethiopia’s Repressive Regime. #WHA70 May 5, 2017

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AP News: UN HUMAN RIGHTS CHIEF: ETHIOPIA BLOCKED ACCESS TO PROTEST AREAS

For Opponents, WHO Director General Nominee Tedros Adhanom Represents Ethiopia’s Repressive Government

Some Ethiopians are fiercely campaigning against Tedros Adhanom, Ethiopia’s candidate to replace Margaret Chan Fung Fu-chun, as director general of World Health Organization, just a few weeks before member states are set to vote on the final three candidates.

Tedros, a former Ethiopian foreign and health minister, along with Pakistan’s Sania Nishtar and the UK’s David Nabarro are the three director-general nominees who made the cut from a larger pool of candidates in January.

Tedros, who is running a well-funded campaign, is considered as a prime contender in the race. His candidacy was endorsed by the African Union, and just last week he picked up an endorsement of Andrew Mitchell, the UK’s former international development secretary.

However, he is facing unrelenting opposition from his own citizens.

Ethiopians who feel marginalized by their country’s government are campaigning hard against him online, arguing he should not be elected because he represents the interests of Ethiopia’s autocratic ruling elites and not the people.

The irony is beyond tragic. The person who is responsible for the crimes against humanity in is running for !

They have set up online petition pages against Tedros and produced a documentary film detailing what they consider to be his failures and his alleged mismanagement of funds while he was Ethiopia’s health minister.

Tedros Adhanom presided and participated in the biggest financial corruption scandal of misusing Global fund in Ethiopia.

They have organized Twitter campaigns under a hashtag #NoTedros4WHO to organize conversations surrounding the topic. To make his Ethiopian government profile at the top of the public’s consciousness, his opponents have share detailed research that accuses Tedros of inefficiencies, misreporting, and exaggerations of his achievements when he used to serve in Ethiopia.

However, amid fears that the campaign might diminish his chances, government groups are also running a parallel campaign supporting his candidacy. They have downplayed the opposition as unpatriotic, mean-spirited and trivial jealousy.

Since April 2014, a popular protest movement in Ethiopia has challenged the government, which has responded brutally. According to Human Rights Watch, at least 800 people have died, and thousands of political opponents and hundreds of dissidents have been imprisoned and tortured. Since October 2016, authorities have imposed some of the world’s toughest censorship laws after it declared a state of emergency.

The role of ethnic politics

Some of Tedros’ detractors say they oppose his candidacy because of his alleged incompetence. But a big part of what drives the fierce opposition to Tedros is the logic of ethnic politics.

Tedros holds a Ph.D. from the University of Nottingham in community health. He studied biology at Asmera University before he completed a master’s degree in immunology of infectious diseases in London.

When people hear his name, as qualified as he may be, his opponents associate him with a repressive Ethiopian government that has killed people, jailed thousands of political opponents, and imprisoned and tortured dissidents.

His meteoric rise to power started soon after he finished his Ph.D. in 1999 when he was tasked to lead the Tigray region’s health department. After two short years in Tigray, he was promoted to Ethiopia’s minister for health by the late prime minister Meles Zenawi, a Tigrayan himself. In 2012 when Meles Zenawi died, Tedros became Ethiopia’s foreign minister.

Tigray is one of the nine regional states that are federated based on ethnolinguistic compositions.

Over the past 26 years, the Tigrayan elites have taken center stage in Ethiopia’s political affairs, largely due to their control of the military, security and the economy of Ethiopia. Though accounting for only 6% of Ethiopia’s population, all senior positions of country’s military and security and the most meaningful positions in state institutions are packed by Tigrayan elites. This has always been a sore point with the elites of the Oromo and Amhara ethnicities, who together comprise 65% of Ethiopia’s population.

Ethiopia’s government has used authoritarian tactics against its people and the country’s politic space is a closed one; however, it enjoys the support of powerful countries such as the United States and the United Kingdom.

Domestic disputes on a global platform

The vigorous opposition to the Tedros candidacy suggests that Ethiopians political struggle has spilled over into the international arena. In some sense, it also suggests that these global platforms have become a substitute for a repressed domestic political space.

Since Ethiopia’s local political institutions and communications infrastructure are controlled by the government, diaspora groups, however sporadic and uncoordinated their efforts may be, have used the opportunity to shed light on the human rights violations using Twitter campaigns.

A twitter campaign on today April 28th Europe Time 18:00 And 12:00 PM Washington DC USA Time 17:00 Uk time Key tags &

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HUMAN RIGHTS AND THE ELECTION OF THE NEXT WHO DIRECTOR-GENERAL: PUBLIC ACCOUNTABILITY NOW March 18, 2017

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HUMAN RIGHTS AND THE ELECTION OF THE NEXT DIRECTOR-GENERAL: PUBLIC ACCOUNTABILITY NOW

BY , Oneill Institute, 15 March 2017

 

I believe that human rights, and the right to health in particular, should be a top priority of and guiding principle for the next WHO Director-General, whom the world’s health ministers will choose at the World Health Assembly in May. Human rights, after all, encompass the values needed to achieve health for all and health justice, such as equity, non-discrimination, universality, participation, and accountability. They are legally binding precepts. Above all, they embrace human dignity, and the utmost respect for all people in health systems and health-related decisions. They embody the notion of people-centered health services.

This importance demands electing to the post a credible and strong leader on human rights, someone with a history of fighting injustice, of opposing human rights violations, of standing up for the marginalized and oppressed, of resisting political, corporate, or other interests that stand in the way of human rights. This centrality of human rights means electing an individual willing to stand against forces and policies that tolerate or even perpetuate discrimination, or that let political or other concerns override the rights of women, minorities, immigrants, political opponents, or anyone else. It entails appointing a person who views organizations fighting for human rights as partners, even when their own governments may oppose them.

Three candidates remain in the race to be the next WHO Director-General: Tedros Adhanom, David Nabarro, and Sania Nishtar. All candidates should be accountable for their past support of human rights, and outline their plans for furthering human rights around the world if chosen to lead WHO. While it is important for all candidates to do this, one candidate in particular ought to provide a detailed public account of where he stands, and has stood, on human rights. Having spent more than a decade as a cabinet minister in a government that has committed large-scale human rights abuses, Dr. Tedros must make clear his position and intention.

Dr. Tedros served as Minister of Health of Ethiopia from 2005 through 2012, when he became Minister of Foreign Affairs, remaining in the post until a cabinet reshuffle last November. He was, and remains, a member of the Central Committee of the Tigray People’s Liberation Front (TPLF), long the country’s dominant political party, of the more select, nine-member TPLF Executive Committee, and of the Executive Committee of the Ethiopian People’s Revolutionary Democratic Front (EPRDF), the ruling coalition.

Some background on human rights in Ethiopia is in order. It is a country where the ruling coalition won all 547 seats in its most recent (2015) parliamentary election, which surely says much more about the state of democracy than the government’s popularity. Freedom House rates Ethiopia as “not free,” ranking it below than many other of the “not free” countries (p. 18) and with one of the world’s largest declines in freedom over the past decade (p. 10).

In its World Report 2017, Human Rights Watch calls the media in Ethiopia “under government stranglehold,” with at least 75 journalists fleeing into exile since 2010, and others arrested. A 2009 law “continues to severely curtail the ability of independent nongovernmental organizations.” Security forces “frequently” torture political detainees, of whom there are many. Over the past decade, Ethiopia has denied entry to all UN human rights special rapporteurs, other than on Eritrea.

The Ethiopian government’s repressive ways gained international prominence at the Rio Olympics last summer. As he crossed the finish line, winning the silver medal, Ethiopian marathon runner Feyisa Lilesa crossed his arms as a symbol of protest against the government’s violent response to protests in the Ethiopia’s Oromia region. Two months earlier, Human Rights Watch had released a report detailing the government’s violent response to the protests, the most recent round of which began in November 2015. They broke out in response to the government clearing land for an investment project. This fed into wider fears about farmers being displaced without adequate consultation or compensation as part of a master plan to massively expand the boundaries of Addis Ababa, the capital, into the neighboring Oromia region. Adding fuel to the protests were environmental and other local concerns, and longer-standing grievances among members of Ethiopia’s largest ethnic group, the Oromo, of political, economic, and cultural marginalizationAmnesty International reported that least 800 protesters had been killed by the end of 2016.

Ethiopia’s Ministry of Foreign Affairs posted a blog on its official website in October 2016 (when Dr. Tedros was still Foreign Minister) in response to Human Rights Watch’s reporting on Ethiopia. The piece accuses Human Rights Watch of baseless allegations, intentionally misleading its audience, and propagating “scare stories.” It focuses on the NGO’s response to an October stampede during an anti-government protest at an annual festival in Oromia, though addresses Human Rights Watch’s reporting in Ethiopia more generally. Yet Human Rights Watch is widely recognized to employ a gold standard of research. The above-mentioned report, for example, was based on more than 125 interviews, “court documents, photos, videos and various secondary material, including academic articles and reports from nongovernmental organizations, and information collected by other credible experts and independent human rights investigators.” All material in the report was verified by two or more independent sources.

In light of Ethiopia’s severe human rights abuses and Dr. Tedros’s prominent position within the ruling party and the government, a natural question becomes: What was his role in the country’s systematic abuses of human rights?

I do not know the answer, or the veracity of other charges that Ethiopian diaspora organizations have lodged. In his role in the TPLF and ERPDF power structures, is it possible that he tried to change things from the inside, using his position of power within the government to oppose the government’s repression?

What we do know, though, based on the independent reports of Human Rights Watch, Amnesty International, the U.S. State Department, and others, is that the human rights situation in Ethiopia is dire. And Dr. Tedros has long been an important member of the government.

Dr. Tedros has committed to an open and transparent approach to running WHO. Now is the time for him to demonstrate this commitment, publicly addressing the concerns about human rights during his time in the Ethiopian government, and his role, including as a member of the power structures of the ruling party and coalition. States should evaluate his answers carefully and in light of other evidence.

States should also consider whether regardless of Dr. Tedros’s actions within the government – perhaps unless he vigorously fought against rights-abusive policies from the inside – the mere fact of having served (particularly for a considerable length of time) in a high-level post of a government that perpetuates such severe human rights abuses should be an automatic disqualifier from any international leadership position. Would electing someone put forward by such a government, particularly someone who has long served in that government, in some way represent the international community endorsing, accepting, the legitimacy of that government and its policies, and diminish the importance we ascribe to human rights?

We live in an era where human rights remain under great threat. Especially at such times as these, it is vital that states vote for a candidate whose record and integrity will enable them to lead WHO into a new era of health and human rights.