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We occasionally publish opinion and commentary on significant issues and we segregate such content from our regular weekly digest – Vaccines and Global Health: The Week in Review. Please forward any comments to me as below. Apologies for those seeing this as a cross-posting :

David R Curry, MS
Executive Director
– email: david.r.curry@centerforvaccineethicsandpolicy.org

,

3 November 2016

Observations and Comment:: Beware of Kingdoms bearing Gifts – Gavi, Yemen and $25 million from Saudi Arabia

We stand in awe at the courage and tenacity of front-line vaccinators and other public health workers who help assure immunization services are delivered – even in dangerous and unstable contexts like Syria, South Sudan and Yemen, to name just a few.

Of course, the danger faced by those who vaccinate and those needing immunization is compounded when conflicts extend to attacks on health care facilities, schools, homes and other civilian infrastructure – places where vaccination is typically received.

Sometimes these attacks are perpetrated by non-state actors, sometimes by states against their own citizens, and sometimes by coalitions of states supporting one side or another in a conflict.

Yemen is a tragic example, where a continuing, brutal conflict is playing out. A coalition led by Saudi Arabia is an active belligerent in this conflict. Further, the coalition is implicated in – and is sometimes acknowledging— strikes on a range of civilian targets resulting in deaths, causalities, and infrastructure damage. Inevitably, children are among the dead and injured. [1-3]

So, we paused when we read the Gavi press release from 5 October 2016 [4] which welcomed Saudi Arabia’s contribution of $25 million to “help Vaccine Alliance partners save children’s lives” in Yemen.

We stopped when we read that the contribution will enable Gavi to “…continue support for immunisation programs and strengthen health systems in Yemen, and ensure a healthy future for children today and for generations to come.”

Wouldn’t these be, in principle, the same children and same health systems that have been targeted by the Saudi-led coalition? Aren’t these acts of aggression being decried as clear violations of international humanitarian law [IHL] and potential war crimes? [5]

The press release further notes that “Yemen has been in the grip of a severe political crisis since 2011 descending into a major armed conflict.” It does not mention the role of the Saudis in that crisis.

The press release also includes an extraordinary quote from a Saudi official which claims “The Kingdom’s endeavour is to maintain its role in the area of social responsibility, through the fulfilment of its obligations to the local and international community, and it will continue to play this role in the future”.

Really?

Finally, the press release notes that this donation “…marks the first time the Kingdom of Saudi Arabia has provided funding to Gavi.”

We were so dismayed by this announcement that we raised the following questions with our colleagues at Gavi:

:: does Gavi have any policy apparatus in place which guides acceptance or deferral of a restricted grant from a state (such as the Saudi grant) which specifies a second country where the funds will support immunization?

:: does that policy, if extant, provide for deferrals or refusals when the grantor may be a belligerent in an ongoing conflict in the “beneficiary” country?

:: does Gavi recognize the political, reputational, and ethical issues that emerge when the grant from the Saudi government is earmarked for Yemen and immunization programs there, while the Saudi-led coalition is clearly and flagrantly violating IHL through continuing and apparently indiscriminate attacks on civilian sites in Yemen? …Indeed, when such attacks result in civilian casualties, which presumably include children who would benefit from the immunization services funded by the donation?

The response we received was – just as dismaying – a non-response.

Gavi included further information on the factual context of the Saudi contribution and its timing, and included its current child protection and ethics policy statements. None of this addressed any of the questions raised above.

We urge our valued colleagues at Gavi to review their donations policy apparatus, raise their contextual awareness, and take meaningful action to reconsider the terms of this donation.

Acting as if there is no connection between this donation and the situation on the ground in Yemen does not serve Gavi’s standing as a well-governed, effective, ethical non-state actor.

But more important, it does not properly serve the children of Yemen – who continue to suffer in coalition strikes against their homes, schools, health facilities, and other civilian spaces – albeit more fully immunized through support from that coalition’s lead state.

# # # #

Selected References
[1]
WHO: Health services decline as conflict in Yemen continues
28 September 2016
In Taiz governorate alone, more than 70% of health facilities are not or partially functioning.Sana’a, 28 September 2016— Yemen’s 18-month conflict has led to depletion of health services, with more than 1900 out of 3507 health facilities in 16 governorates currently either not functioning or partially functioning, closing access to much needed essential health services to thousands of Yemeni people…

[2]
Yemen: MSF releases detailed documentation of attacks on two medical facilities ahead of UN Security Council closed session on protection of medical mission
Member states must advance concrete measures to protect access to medical care in conflict zones
27 September 2016
:: Download Yemen Abs investigation summary report (PDF)
:: Download Taiz investigation report (PDF)
After conducting internal investigations, Médecins Sans Frontières (MSF) is releasing two reports describing attacks on medical facilities it runs or supports in Yemen. The two attacks combined resulted in the death of 20 people, most of them patients, and wounded 32 others. Both attacks were acknowledged by the Saudi-led coalition (SLC). The attacks were on a hospital in Abs, Hajjah governorate on 15 August 2016, and on the MSF clinic in Taiz city on 2 December 2015. The reports detail the actions taken before, during and immediately after the airstrikes. MSF is engaged with the military leadership of the SLC and have raised our serious concerns about the attacks.

Beyond the immediate loss of life and destruction caused by the bombings, the attacks led to a suspension of activities that left an already very vulnerable population without access to healthcare. As a consequence of the bombing of Abs hospital, MSF withdrew from six hospitals in northern Yemen.

While there are significant differences in the circumstances surrounding each incident, in both cases, the bombings hit fully functioning health facilities and the protected nature of the medical mission was not respected. The internal investigations of the Abs and Taiz incidents also conclude that the neutrality and impartiality of the facilities had not been compromised before the attacks and therefore there was no legitimate reason to attack them. The details of the incidents documented in these two reports are unambiguous indicators of how war is being waged in Yemen, where there is an utter disregard for civilian life by all warring parties…

[3]
One in three Saudi air raids on Yemen hit civilian sites, data shows
Pressure on UK and US roles in war set to increase as survey shows school buildings and hospitals among targets
Ewen MacAskill and Paul Torpey
The Guardian
Friday 16 September 2016 10.12 EDT Last modified on Friday 30 September 2016 07.03 EDT
More than one-third of all Saudi-led air raids on Yemen have hit civilian sites, such as school buildings, hospitals, markets, mosques and economic infrastructure, according to the most comprehensive survey of the conflict.
The findings, revealed by the Guardian on Friday, contrast with claims by the Saudi government, backed by its US and British allies, that Riyadh is seeking to minimise civilian casualties.
The survey, conducted by the Yemen Data Project, a group of academics, human rights organisers and activists, will add to mounting pressure in the UK and the US on the Saudi-led coalition, which is facing accusations of breaching international humanitarian law…

[4]
Gavi welcomes contribution of US$ 25 million from the Kingdom of Saudi Arabia
Investment will help Vaccine Alliance partners save children’s lives through immunisation in Yemen
Riyadh, 5 October 2016 – The Kingdom of Saudi Arabia has agreed to contribute US$ 25 million to support childhood immunisation programs through Gavi, the Vaccine Alliance. The multi-year pledge from the Kingdom of Saudi Arabia will contribute towards efforts to immunise children and support health system strengthening in Yemen.

“The Kingdom of Saudi Arabia is a key partner in global health and development and this pledge underlines the country’s unwavering commitment in these areas,” said H. E. Dr. Ngozi Okonjo-Iweala, Chair of the Gavi Board. “Through the contribution of donors such as the Kingdom of Saudi Arabia we are able to continue support immunisation programs and strengthen health systems in Yemen, and ensure a healthy future for children today and for generations to come. I would like to thank the Custodian of the Two Holy Mosques King Salman Bin Abdul Aziz, the Saudi government and the Saudi people for this generous support.”

Yemen has been in the grip of a severe political crisis since 2011 descending into a major armed conflict. Despite serious challenges faced by the country’s already-fragile health systems, Yemen managed to sustain its routine immunization coverage in 2015. Thanks to Gavi funding and support from Alliance partners, such as UNICEF and WHO, 67% of children in Yemen received a full course of the five-in-one pentavalent vaccine in 2015. Gavi will continue to support pentavalent, pneumococcal, rotavirus and inactivated polio vaccine programmes as well as health system strengthening in Yemen between 2016 and 2020.

The contribution, which was first pledged at the Gavi Pledging Conference, held in Berlin in 2015, will be matched by the Bill and Melinda Gates Foundation and marks the first time the Kingdom of Saudi Arabia has provided funding to Gavi.

H. E. Eng. Yousef Al-Bassam, Vice Chairman and Managing Director of the Saudi Fund for Development (SFD), said “The Kingdom’s endeavour is to maintain its role in the area of social responsibility, through the fulfilment of its obligations to the local and international community, and it will continue to play this role in the future”. He said many diseases, particularly those targeting children, can be eliminated through consolidating the international community’s efforts and providing the necessary financial support for the purchase of vaccines.“ Mr. Al-Bassam highlighted the need to spread awareness about the risk of vaccine-preventable diseases through families and communities.

[5]
The situation in Yemen – Security Council, 7797th meeting
31 Oct 2016 – Security Council 7797th meeting, on the situation in the Middle East (Yemen).
[Video: 2:36:06]

UNDER-SECRETARY-GENERAL FOR HUMANITARIAN AFFAIRS AND EMERGENCY RELIEF COORDINATOR, STEPHEN O’BRIEN
Statement to the Security Council on Yemen
31 October 2016