A Critical Time for Global Right to Health

By the time South Africa went into hard lockdown in March 2020, I was completing a self-imposed quarantine as I had travelled to Geneva, Switzerland.  I was leading a delegation to the human rights council to deposit a report prepared by the South African commission for gender equality (CGE) to the pre-working group of the Committee on the Elimination of discrimination against women (CEDAW).

Upon landing in South Africa, Switzerland was on the travel high risk list, as coronavirus that caused COVID-19 infection was still dynamic and emerging - it was the responsible thing to do. I had to confront all the possibilities and the most scary, the real possibility of getting COVID-19 infection, and even death. I even updated my ‘in-case-of-emergency’ (ICE) contacts, I thought I was prepared for the uncertainty. However as the days went by, isolated in my own home, the mental health started to take a knock.  I had anxiety about my family back in Qwa-Qwa, a former Bantustan in the Free State province, and many communities like them, particularly, the abnormal situation of frequent water cuts and lack of clean and safe water, was all I could think about.  The public health communication and campaigns were correctly emphasising the need to wash hands regularly for 20 seconds, yet we have communities who do not even have a consistent supply of clean and safe water.  How is it so easy for leaders to be so far removed from the experiences of millions of people? Even buying a sanitiser requires surplus money that many simply do not have.

A century ago, W. E. B. Du Bois  recognised the connection between societal inequities and health inequities, raising several central arguments related to racism, poverty, and other social problems. The right to health is an inclusive right, and COVID-19 forced us to confront these existing structural fault lines that extend not only to timely and appropriate health care, but also to the underlying determinants of health. The right to health is interconnected and indivisible from other rights, such as the right to an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions. These entitlements include the right to a system of health care and the underlying social determinants of health.

As a medical doctor, I also know the impact of a lack of safe and clean water, I spent many years working as a paediatric emergency medical officer, and treating children with diarrhoeal diseases. This global pandemic has further exposed the harsh conditions that many people were already living under.  COVID-19 found many health systems inadequately financed, already lacking in planning for disasters, and suffering from a lack of agility to respond without threatening other health services.

It is impossible and frankly irresponsible to ignore how the virus’ impact has been worsened by public health policy that is devoid of human rights approach, poor leadership at all levels of care, persisting socio-economic inequalities, systemic racism that continues to burden individuals for systemic failures, and structural discrimination. This meant that despite lockdown regulations, many people could simply not afford to stay home and not work, and those ‘essential’ workers are some of the lowest paid workers, with no health insurance, and many of whom are from marginalized communities. Important to note that many of them are women in industries with poor or no labor protections. In addition, many women, gender-diverse persons and children were entrapped, in lockdown with their abusers.  Absolute devastation.

At the 75th session of the General Assembly, in my capacity as the United Nations Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, I shared my vision to gain a deeper understanding on the negative impact of coloniality, racism and the oppressive structures embedded in the global health architecture, which disproportionately impacts Black people, indigenous peoples and people of colour communities, as well as those in developing countries.  As per the mandate, the Special Rapporteur is tasked to apply a gender perspective in the execution of her mandate and to pay attention to the situation of "vulnerable and marginalised groups”.

In my response to oral questions posed by member States, I pointed out that the starting point for millions of people is unequal, and the negative impact of what health systems worldwide lack in resourcing, for example, testing kits took long to arrive in many countries; others are still struggling with diagnostics technology, others struggle to access care and therapeutics, including the vaccine. The pandemic does present an opportunity to address multilateralism and the multiple dimensions of structural racism that fundamentally cause health disparities as well as the embedded corruption in the health sector, where even before covid-19, health budgets allocated for health services and related provisions, did not yield the results because of mal-administration and power imbalances with the relationship of recipients and donors of health aid.

As we look forward to a post-covid pandemic era, it is important to adhere to the public health advice on social distancing, wearing of masks, washing hands; the vaccine undeniably provides the global community an opportunity to save more lives.  The only way to do so is to ensure that vaccines that have been developed are fully accessible, acceptable, of quality and available to all. Vaccine hoarding by richer countries will fall short of their intended outcome. It will only delay millions of people getting life saving medicines and lead to many more deaths.

Executive Director of UNAIDS, Ms Winnie Byanyima, reminds us that “we have a commitment to stand up for the most vulnerable, even in the tough environment COVID-19 has put us in.”

Contrary to the popular statement, COVID-19 is not an equaliser. In fact, it is precisely because of historical and current human rights abuses and violations that States must be reminded of their obligations “to take positive measures that enable and assist individuals and communities to enjoy the right to health.”

The pandemic has continued the marginalisation of millions of people who are in vulnerable situations, who are often neglected from health services, goods and facilities - those living in poverty, women, survivors of gender-based violence, indigenous peoples, people with disabilities, older persons, minority communities, internally displaced people, persons in overcrowded settings and in residential institutions, people in detention and prisons, people experiencing homelessness, migrants and refugees, people who use drugs, LGBTI and gender diverse persons.

For millions of people throughout the world, the full enjoyment of the right to the highest attainable standard of physical and mental health remains an unmet goal.

The loss, the bereavement and anxiety as a result of this global pandemic, and for many people the worst disaster in their lifetime, must lead us to a better place as a global community.  There is only one way out of this despair, it is through protection of human rights, international cooperation, solidarity, improved health systems that protect human rights, better transparency and accountability.

“The views expressed herein are personal and do not necessarily reflect the views of the United Nations”