Featured Journal Content

The Lancet
Jan 26, 2019 Volume 393Number 10169p295-376, e3-e4
https://www.thelancet.com/journals/lancet/issue/current
Editorial
At the turn of the tide: human rights and health in 2019
The Lancet
A pattern of political turmoil, violence, and intolerance in all corners of the world, from Europe to Asia and the USA, is following a rise of populist leaders and authoritarian governments. Human rights are under autocratic threat. Once-influential rights defenders, such as the USA, have faded away, risking a void in the global defence of human rights. This gloomy reality is underscored in Human Rights Watch’s World Report 2019, released Jan 17, which summarises key human rights issues in nearly 100 countries and territories worldwide. This year’s annual report sends a clear message: that human rights violations propagated by autocratic leaders throughout 2018 continue to imperil the health of the world’s most vulnerable populations.

Inequality and discrimination fuelled much of the harm in 2018. Immigration became one of the most divisive issues among autocratic leaders in Europe. The failure to establish protective measures for people with migrant and refugee status restricted their access to health care. Some European governments, such as the Italian and Hungarian regimes, prevented migrants from entering their countries and fuelled rising anti-immigrant sentiment. In the USA, President Trump separated immigrant children from their parents. In southeast Asia, more than 1 million Rohingya Muslims remain locked in a cycle of poor child health, malnutrition, waterborne illness, and poor obstetric care after decades of discrimination—a situation that has worsened drastically because of a brutal crackdown by the Myanmar army.

Attacks in armed conflict zones against hospitals and threats to health-care staff continued to be problematic. In Yemen, in what UN officials describe as the world’s largest humanitarian crisis, bombings and blockade by Saudi-led coalitions hampered the movement and safety of health-care staff, patients, and ambulances. Similar examples of attacks on health-care facilities were reported in the Gaza Strip and in areas of war-ravaged Syria.

Restricted supply of food and basic medical supplies in countries experiencing financial turmoil have threatened the health and safety of their populations. Under President Nicolás Maduro’s leadership, Venezuela’s infrastructure has crumbled and an economic collapse has triggered a historic exodus of civilians. The country’s health-care system is decaying, triggering a rise in the rates of maternal and infant mortality and a spike in cases of malaria and diphtheria.

But there are reasons for hope. Unlike previous annual reports, World Report 2019 paints a brighter picture of the future. In his introductory essay, Executive Director Kenneth Roth explains that, amid political chaos and despite mounting pessimism around rights abuses and attacks on democracy by populists on both the far left and far right, 2018 was a remarkable year for human rights. This is not because of growing authoritarian tendencies, but because of resistance to them. “Important battles are being won, re-energising the global defence of human rights”, states Roth. The pushback to autocracy was striking because it took unexpected forms—from elections, street demonstrations by civilians, both regionally and nationally, to non-traditional coalitions between smaller countries and organisations, the UN, and the European Parliament. 2018 saw unprecedented international efforts to resist attacks on democracy in Europe and Africa, to halt the Saudi-led bombing and blockading of Yemeni civilians, to prevent further bloodshed in Syria, and to take measures that will one day bring to justice the perpetrators of attacks against Rohingya Muslims in Myanmar. Latin American governments united with Canada to urge the International Criminal Court to open an investigation of crimes in Venezuela. Democrat gains in the House of Representatives in the autumn midterm elections reflect, at least in part, a national dismay of Trump’s anti-immigrant rhetoric.

This rise of resistance against the autocracy must not lose momentum in 2019. Every day, in so many parts of the world, the health of women and children is attacked and reproductive rights are violated. In countries facing the consequences of pollution and climate change, or fighting outbreaks of infectious disease, vulnerable, marginalised, and minority populations are being overlooked. An access abyss in palliative care persists, and mental health is still neglected. Much of the pushback in the past year played out at the UN and the European Parliament, underlining the importance of solidarity and the collective voice. This global unity is a force that needs to be harnessed to truly shift the power dynamics in 2019 and to make it a year of triumph for both human rights and health. It will be a tough journey.