he World Health Organization (WHO) has concluded that half of the world’s population lacks access to essential health services. One particularly revealing metric by the WHO is that several dozen countries don’t even meet the basic, minimum requirements for per-capita hospital density, a leading indicator of healthcare limitations. The COVID-19 crisis worsened the situation, as almost all of the 105 countries surveyed by the WHO in 2020 had health services disrupted, and elective and routine treatment were completely suspended.
Even before the COVID-19 pandemic, the WHO, Organization for Economic Cooperation and Development (OECD), and the World Bank found that poor quality healthcare and lack of access to care increased the burden of illness and healthcare costs globally. Research by the McKinsey Global Institute concluded that poor health reduces global GDP by 15% each year, and that prudent investments in health could generate $12 trillion in economic opportunity, save hundreds of millions of lives, and establish better health across the world. While all countries bear this burden, the WHO found in April 2023 that health care delivery in areas of conflict and crisis is the second most urgent global health challenge. Only addressing the global impact of climate change is considered more urgent.
The WHO Constitution of 1946 conceptualizes healthcare as a human right, stating “the highest attainable standard of health as a fundamental right of every human being.” This confers states with an international legal obligation to its citizens. A final but important key metric is the UN’s 2030 Sustainable Development Goals, which includes SDG3 to “ensure healthy lives and promote well-being for all at all ages.”
If states are already struggling to meet the healthcare needs of their citizens, they are less able to address crisis situations, such as natural and man-made disasters and the humanitarian effects of conflict and war.
The Case of Sudan
Sudan is a case in point. Sudanese officials barely averted a complete collapse of its health system earlier this year. And while nations can never be fully prepared for the impact of conflict, particularly attacks on health facilities, the question remains—would more robust investments in Sudan’s health system have made Sudan better prepared to address the healthcare crisis that it now faces?
In the weeks after the crisis in Sudan, only 16% of the medical institutes in its capital city of Khartoum were working at full capacity and 70% of hospitals in conflict zones were shut down. Hospitals were targeted throughout the fighting, causing medical staff to flee or take shelter, disrupting the provision of care. The conflict in Sudan will also generate long-term health challenges including disease outbreaks, threats to healthy pregnancies and child mortality rates, increases in disabilities, treatment of chronic diseases, health access, and health infrastructure.
This dire situation is occurring in a country that faced significant health and healthcare challenges well before conflict started. Sudan’s health system had been chronically underfunded for decades, and more recently, both an economic crisis and the COVID-19 pandemic drained the country of its resources. Sudan’s percentage of doctors per inhabitant in 2017 was almost six times below the global average at 0.3 per 1000 residents, and 70% of all healthcare workers were in Khartoum. Citizens in several regions have few to no health consultations, access to skilled health workers, and less than a third of needed medications are available at public and private facilities.
It is difficult for any society to be prepared for a health crisis of the magnitude unfolding in Sudan. However, making long-term investments in healthcare before conflict occurs is essential, as is the commitment to support the health rights of all citizens. Sudan’s healthcare needs were well documented before Sudan’s current crisis, including better legal enforcement of healthcare policies, stronger communications between all levels of policy making, closer monitoring of health implementation and outcomes, and improvements in data quality and systems. In short, Sudan needed more accountability, more coordination, and better technology.
For countries like Sudan must seek to accelerate investments in medical personnel and infrastructure. These investments would increase doctor-to-patient ratios; create resilient, mobile, and flexible medical facilities that can better serve populations; and support access to routine care to help stymie disease. Simply providing more doctors, beds, and hospitals would go a long way towards improving Sudan’s health system and would better prepare any healthcare system for crisis.
To be sure, there are limits to what can be done to lessen the tragedies caused by conflict. At the same time, there are necessary and prudent steps all societies can take to become more resilient and better prepared for crisis situations. The international community must support countries like Sudan to ensure the basic human right to healthcare to support citizens during crises and in times of peace. This is the right of all people.
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Health and Wellbeing as a Fundamental Right
Desert in Sudan. Photo by Yiannis Mantas via Adobe Stock.
October 15, 2023
Half the world's population lacks access to essential health services, with dozens of countries not even meeting minimum requirements for hospitals per capita. When these countries suffer crises, the situation becomes far worse, writes Ulrich Marseille.
he World Health Organization (WHO) has concluded that half of the world’s population lacks access to essential health services. One particularly revealing metric by the WHO is that several dozen countries don’t even meet the basic, minimum requirements for per-capita hospital density, a leading indicator of healthcare limitations. The COVID-19 crisis worsened the situation, as almost all of the 105 countries surveyed by the WHO in 2020 had health services disrupted, and elective and routine treatment were completely suspended.
Even before the COVID-19 pandemic, the WHO, Organization for Economic Cooperation and Development (OECD), and the World Bank found that poor quality healthcare and lack of access to care increased the burden of illness and healthcare costs globally. Research by the McKinsey Global Institute concluded that poor health reduces global GDP by 15% each year, and that prudent investments in health could generate $12 trillion in economic opportunity, save hundreds of millions of lives, and establish better health across the world. While all countries bear this burden, the WHO found in April 2023 that health care delivery in areas of conflict and crisis is the second most urgent global health challenge. Only addressing the global impact of climate change is considered more urgent.
The WHO Constitution of 1946 conceptualizes healthcare as a human right, stating “the highest attainable standard of health as a fundamental right of every human being.” This confers states with an international legal obligation to its citizens. A final but important key metric is the UN’s 2030 Sustainable Development Goals, which includes SDG3 to “ensure healthy lives and promote well-being for all at all ages.”
If states are already struggling to meet the healthcare needs of their citizens, they are less able to address crisis situations, such as natural and man-made disasters and the humanitarian effects of conflict and war.
The Case of Sudan
Sudan is a case in point. Sudanese officials barely averted a complete collapse of its health system earlier this year. And while nations can never be fully prepared for the impact of conflict, particularly attacks on health facilities, the question remains—would more robust investments in Sudan’s health system have made Sudan better prepared to address the healthcare crisis that it now faces?
In the weeks after the crisis in Sudan, only 16% of the medical institutes in its capital city of Khartoum were working at full capacity and 70% of hospitals in conflict zones were shut down. Hospitals were targeted throughout the fighting, causing medical staff to flee or take shelter, disrupting the provision of care. The conflict in Sudan will also generate long-term health challenges including disease outbreaks, threats to healthy pregnancies and child mortality rates, increases in disabilities, treatment of chronic diseases, health access, and health infrastructure.
This dire situation is occurring in a country that faced significant health and healthcare challenges well before conflict started. Sudan’s health system had been chronically underfunded for decades, and more recently, both an economic crisis and the COVID-19 pandemic drained the country of its resources. Sudan’s percentage of doctors per inhabitant in 2017 was almost six times below the global average at 0.3 per 1000 residents, and 70% of all healthcare workers were in Khartoum. Citizens in several regions have few to no health consultations, access to skilled health workers, and less than a third of needed medications are available at public and private facilities.
It is difficult for any society to be prepared for a health crisis of the magnitude unfolding in Sudan. However, making long-term investments in healthcare before conflict occurs is essential, as is the commitment to support the health rights of all citizens. Sudan’s healthcare needs were well documented before Sudan’s current crisis, including better legal enforcement of healthcare policies, stronger communications between all levels of policy making, closer monitoring of health implementation and outcomes, and improvements in data quality and systems. In short, Sudan needed more accountability, more coordination, and better technology.
For countries like Sudan must seek to accelerate investments in medical personnel and infrastructure. These investments would increase doctor-to-patient ratios; create resilient, mobile, and flexible medical facilities that can better serve populations; and support access to routine care to help stymie disease. Simply providing more doctors, beds, and hospitals would go a long way towards improving Sudan’s health system and would better prepare any healthcare system for crisis.
To be sure, there are limits to what can be done to lessen the tragedies caused by conflict. At the same time, there are necessary and prudent steps all societies can take to become more resilient and better prepared for crisis situations. The international community must support countries like Sudan to ensure the basic human right to healthcare to support citizens during crises and in times of peace. This is the right of all people.
