Tedros Adhanom Ghebreyesus: peace is the best medicine

Largest displacement crisis globally

In September I visited Sudan and saw the effects of its civil war and met people who are paying the price: many are displaced, hungry, and sick, watching their children waste away from malnutrition. The next week in neighbouring Chad, I met some of the 900 000 Sudanese refugees who have fled, seeking security and food.6

Sudan is now the largest displacement crisis globally: 11.2 million people are internally displaced, and a further 3.2 million have fled to Chad or other neighbouring countries.6 Women and girls have been raped, and many more live in fear of such violence; some have died by suicide.

I visited Ukraine in 2022, shortly after the Russia’s invasion. I saw health facilities that had been damaged or destroyed in the conflict. At the World Health Organization’s (WHO’s) warehouse in Lviv, I held a paediatric crutch, one of many that WHO was preparing to distribute—a tool that children should need only if they are injured playing sport or climbing trees, not because of bombs. I also visited a reception centre for Ukrainian refugees in Poland, where I met a mother from the Mariupol area, who told her scared young daughter when heavy shelling began, “Don’t worry, it’s just a thunderstorm. It will pass.”

For me, health and peace is not an abstraction, it is my lived experience. I was born in Asmara—then Ethiopia, now Eritrea—and grew up amid conflict. When the shelling began, my mother would put me and my siblings under a bed, piling mattresses on top, in the hope we might be protected if a shell struck our house.

More recently, Ethiopia has been engulfed in conflict, the worst in the region of Tigray from 2020 to 2022, and ongoing conflict in the neighbouring region of Amhara. There have been horrific reports of gender based violence; a study published in BMJ Global Health in 2023 found that more than 40% of women in Tigray experienced gender based violence during the conflict, including almost 10% who were subjected to sexual violence.7

Attacks on healthcare

In each of these situations, the direct health effects of the conflict are compounded by damage—intentional or not—to health infrastructure. At the time of writing, WHO has documented 1234 attacks on healthcare in 2024, in 13 countries and territories, causing 716 deaths and over 1200 injuries of health workers and patients.8

Under international humanitarian law, healthcare must be protected and not militarised.9 Even when health facilities are used for military purposes—which itself constitutes an attack on healthcare—they are protected. Parties always have a duty to warn, and the principles of proportionality and distinction between civilians and combatants always apply.10

Since WHO started monitoring attacks on healthcare in 2018, we have verified more than 7400 attacks in 21 countries or territories, with more than 2400 deaths and 5000 injuries, and yet no one has ever been held to account. In November 2024, WHO and the Qatar Foundation launched a report with recommendations on how to protect healthcare in conflict, including establishing a global alliance and a UN special rapporteur; transparent investigations of documented attacks; prosecution when warranted; concrete action by those with power to bring those found guilty to account.11

Health is a bridge to peace

WHO has long worked to promote health as a bridge to peace, beginning with our work in Central America in the 1980s and the concept of “days of tranquillity”—temporary ceasefires to allow for the delivery of essential health services, like vaccination campaigns for children. More recently, humanitarian pauses in fighting have been observed in Gaza to allow for polio vaccination campaigns.

In 2019, WHO launched the Global Health and Peace Initiative, to strengthen the role of WHO and the health sector as contributors to peace—for example, by implementing health programmes that mitigate the risks of inadvertently exacerbating social tensions, contributing to conflict, or undermining social cohesion, and where appropriate, contributing to strengthening dialogue, social cohesion, or resilience to violence.12 By improving equitable access to health services and other common health goals, conflict sensitive health interventions can improve trust and communication between people and governments and foster collaboration and social cohesion.

In Rwanda, for example, many people still carry psychological trauma from the 1994 genocide, which in some cases has been passed down to their children. In 1995, Rwanda became the first African country to have a mental health policy. In partnership with Rwanda and local non-governmental organisations, Interpeace (an international organisation working to prevent violence and build peace) implemented a holistic peace building programme in 2020 involving psychological training for local leaders, a mobile clinic, and mental health capacity strengthening for therapists and facilitators. With government investments in universal health coverage and community based health insurance, Rwanda is a rare success story: life expectancy has risen from around 49 years in 2001 to 69.6 years in 2022.

Similarly, to tackle the need for mental health and psychosocial support at community level after the war in Sri Lanka, the country’s mental health directorate and WHO, together with experts from various fields, developed a community based violence prevention programme called Manohari (positive mind) in 2017. The programme sought to tackle some of the underlying problems contributing to psychosocial problems such as domestic abuse and alcoholism. Identifying the huge stigma that exists around seeking treatment for mental disorders, Manohari prioritises an approach that is simple and tailored to the needs of the community. It is also self-sufficient, in that no external resources are required to train others in the community. Programmes such as Manohari that promote emotional regulation and help diffuse community tensions are important first steps in the journey to rebuild trust and promote reconciliation.

Global cooperation is the only option

WHO was born in 1948, in the ashes of the second world war, as countries united to recognise that the only alternative to global conflict was global cooperation. The authors of WHO’s constitution understood the link between health and peace; the preamble states that “the health of all peoples is fundamental to the attainment of peace and security, and is dependent upon the fullest cooperation of individuals and states.”

In the Democratic Republic of the Congo, Gaza, Haiti, Lebanon, Myanmar, Sudan, Ukraine and elsewhere, WHO and our partners are doing what we can to save lives and alleviate suffering. Ultimately, what the people caught up in these conflicts need more than the aid we deliver is a ceasefire, a political solution, and the best medicine of all—peace.