Hanan Balkhy, WHO chief for Sudan and Iran: work continues despite conflicts

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1:42Hello, I'm BBC journalist Daniel Dazze and this is the interview from the BBC World Service. The best conversations coming out of the BBC. People shaping our world from all over the world. If you're not a little bit afraid, then you're not paying attention. We have never seen a people so united. Do not make that boat crossing. Do not make that journey. Being born in America, feeling American, having people treat me like I'm not. We're more popular than populism. For this interview, I met Dr. Hanan Balki at the Tribe Hotel in Nairobi, Kenya. Dr. Balki is the World Health Organization's Regional Director for the Eastern Mediterranean, one of the six regional WHO offices around the world.

2:28This office covers a total population of nearly 745 million people within a region that spans 22 countries, from Morocco in the west, right across the Gulf towards Pakistan in the east, as well as region as far south as Sudan and the Horn of Africa. The WHO works with governments and local authorities to improve access to basic healthcare and provide support during humanitarian emergencies. Since taking up the post at the beginning of 2024, Dr. Balki has had to navigate the challenges posed by multiple wars within the region, including in Gaza, Sudan, and most recently, Iran. Global supply chains were severely disrupted when the conflict in Iran began just over two months ago.

3:11Although much of the focus of this disruption has been on oil and trade, crucial medical supplies have also been delayed in regions where they are needed to post. What happened during the recent conflict, there was a pause at the time. It was an airspace situation to start with. Once the airspace opened up again, we reprioritized the delivery of those life-saving kits to the member states, and we became back on track to keep the supply chain alive. Because we continued to have to deliver, for example, polio kits to Afghanistan. We had to continue to deliver to support Sudan. Wars and conflicts are never a good thing for survival.

3:48and we really hope that peace can prevail and all of these activities come back to normal again.

3:57Welcome to the interview from the BBC World Service with Dr. Hanan Balki. You're here for the World Health Summit at a time that global health security is seeing a lot of strain. What are these regional shifts you're observing now that you're here? For as the Eastern Mediterranean region of the WHO, of course, we cover around 22 countries, around 750 million people. But I always like to make the clarity of what kind of challenges does this region face? And the conflicts that have been taking place over the past few months have even made the situation worse. So the region has about 40 % of internally displaced population, 50 % of the global humanitarian need.

4:41So one in every 13 person in this region is under humanitarian need. We have the largest number of countries under sanctions. And we also have some huge economic fragility and destruction of healthcare facilities through all of these conflicts that are taking place. So the world is not in a good place today, specifically also when it comes to health security. So there's a lot that we need to do. And the recent escalation in the Gulf also has created even a more compounded situation when it comes to energy production and distribution on top of health commodities. There are some key countries in there like Somalia, like Sudan and a number of others.

5:28But as a region, 14 out of your 22 countries are in some sort of conflict or fragility. How do you handle this? I think, first of all, we have amazing teams. The WHO teams are extremely dedicated from the country office teams to the regional office to our HQ office, our headquarters in Geneva. We have a very robust three-level communication so that the commodities, the norms and standards, the guidance, we all share carrying that heavy, heavy weight. So if I go to the situation that has just happened in the Gulf recently, where the conflict could have went into the wrong direction with either an intentional attack on a nuclear facility or an accidental attack, the WHO had to work with its member states on how do we prepare whether care of duty for our country offices and the UN staff and also supporting the member states on being ready.

6:28The other thing is that we have not been away from conflict, if you will. So this is not the first time that we're facing it. Many of the conflicts in the region are protracted emergencies. So, for example, last year and since 2023, for example, the pre-placement of emergency kits in some of our member states have really saved thousands, if not millions of lives. These emergency kits are kits that are containers that contain commodities that have been studied and identified as the most critical medical commodities that can serve 10 ,000 individuals for a period of three months. So when we pre-place these in countries of conflict, it's easier to deploy them to where they are needed.

7:17So those are some of the examples of how we work. Yeah, but I understand that some of these supply chains have been rocked by this recent conflict you speak of in Iran. The UAE, for instance, I understand was set up to serve about 75 countries and had a response, a stockpile for 500 emergencies. So with that supply chain being affected, how are you reacting to the special nature, the regional nature of the Iran conflict? Great question also, because I think the Dubai hub, which is part of the humanitarian hub, has been really a lifeline saving entity. And it actually grew even bigger during the COVID pandemic.

8:02So we're very thankful to the function of the hub and to the UAE for the support that they have provided to the hub. But that's not the only humanitarian hub that we have. actually being in Nairobi. There's another humanitarian hub that exists here as well. So just to go back to the Dubai hub and what happened during the recent conflict, there was a pause, not a full stop or halt of the functions. There was a pause at the time. It was an airspace situation to start with. Once the airspace opened up again, we reprioritized the delivery of those life-saving kits to the member states, and we became back on track.

8:42So there was commodities going through Saudi Arabia, through Qatar. There was also support from the EU going through paths that went directly to some of our member states because we continued to have to deliver, for example, polio kits to Afghanistan. We had to continue to deliver to support Sudan. But what also happened in the recent conflict is the Strait of Hormuz being blocked and the oil transportation through the Strait of Hormuz has been a problem also. What I worry about today is the increase in the price of energy, the production, because the prices will not reflect immediately. So is there going to be an issue there?

9:26Nutrition is one other thing because of the agriculture constraint that is going to happen because of also some of the products that are needed for the agriculture world. So I think wars and conflicts are never a good thing for survival. And we really hope that peace can prevail and all of these activities come back to normal again. You're talking about how the specifics of the supply chain constraints that have been precipitated by this conflict could affect the health sector in the rest of the world. I'm also a bit more concerned about the humanitarian response that we should be seeing in countries like DRC, in countries like Somalia, in countries like Sudan.

10:07So number one of the things that we need to do in the supply chain, we're working with the member states to make sure that they have as many national regulatory authorities so that they can have oversight on what's coming in. And as we are very mindfully moving forward to a more robust local production, that they can suffice their own needs, but also export to their neighboring countries. So if there's a conflict in one region, then the other countries can continue to support each other if the production is not going to flow into their country. So that's one very critical thing. Number two is how are we going to make sure that the full ingredients of the production can either be locally produced or secured through a diversity of supply chains.

10:53So when a country relies on one source for its commodities, we know that there's going to probably be a problem, either because of manufacturing failure for other technical reasons or because of conflict or supply chains going through. So how do we create that independence and then diversification of sources, whether it's the initial ingredients or the actual importation of products? The other thing that we're working with the member states on more robustly is how are we going to create, not necessarily at the level of the Dubai hub, but how are we going to create sub-hubs for storages? How are we going to create national hubs and subnational hubs as warehouses?

11:36And how are we going to make sure that these warehouses have everything that it needs from the cold rooms to the freezers to the, you know, the shelving, the barcoding, the digitalization of these warehouses? And the dream that I have is that you can sit in a room and you can see, not for every single medical product, but for the essential medical products where one country's shelves are going low, the other country's shelves can't support. And how do we exchange on health products between the countries? That is the essence of the flagship when we say from the region to the region and from one neighbor to another.

12:14How can they continue to support each other on health? What's in for it for the member states is that when a community of one country is secure from outbreaks, the other country is also secure from spillover of infections and other health problems. You're listening to the interview from the BBC World Service.

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13:34Mary, you will flourish. Based on the best-selling novel, The Other Bennett Sister. Now streaming only on Britbox. Watch for the free trial at Britbox.com. If I were asked to describe Dr. Hanan Balki in two words, there would be fierce optimism. This is a woman with one of the toughest jobs in the world, overseeing healthcare in a region that hosts well over half of the world's refugees. And yet, she approaches her work with the smile of a Hollywood star. For every challenge she named, she was quick to point to a solution she would rather implement or a story of resilience she has seen. In conversation, she was disarmingly warm and engaging, the kind of interviewee who forces you to remind yourself that you're there to press for important answers.

14:20And she was just as comfortable discussing her quirky brown loafers as she was unpacking the complex realities of delivering healthcare during conflict. You could almost forget that this is one of the most powerful public health roles in the world and that the decisions she makes affect millions of lives every single day. Okay, let's return to my conversation with Dr. Hanan Balki. I was reading a recent publication from your office, and there was a lot of concern being expressed about how healthcare itself is under attack in some of these fragile regions. Sudan alone has seen 217 attacks on healthcare facilities.

14:59About 37 % of these facilities are not functioning anymore. How do you keep a system running in a condition like that? Yeah, I think, of course, we support the governments on that. And we always come in specifically in countries that have protracted emergencies. So this is not necessarily a new situation in Sudan. The conflict has been going on for now over three years. We have two parts in this scenario that you're talking about, attacks on health care. Number one is that the WHO is mandated through a resolution to report on attacks on health care and advocate for protecting health care. The definition of health care is not just health care facilities.

15:41It is the health care facilities, the warehouses, the health care workers, and everything that relates to health care provision. So that's number one. So we continue to report on it to increase awareness and advocate that under international law, these should be protected. So we want to make sure that we don't continue to normalize and that the world does not normalize the attacks on health care. Once the destruction has happened, the WHO works with the member state. We're working very closely with Sudan on making sure that the basic and the most critical public health functions are sustained during these conflicts.

16:22So that means that during the conflict, they have the capacity and we can support them in that technically and through donations, through our technical expertise on sustaining the surveillance function, for example. Very important. Without surveillance, the first one of the very important functions is that how are we going to know what type of diseases are continuing to cause burden on the health care system and what is emerging because of the conflict. This is very important. Number two, training the emergency medical teams and supporting emergency medical teams to be able to continue to function and train.

16:59Number three is making sure that the major medical commodities can continue to go in to the area that is specifically affected. So these are some of the big areas that we usually focus on in such a situation. Of course, it's not easy, and it will never replace a full functioning healthcare system. And regardless of how much we can offer or other partners can offer, there's harm that's coming to the people. There are people that are not able to get their chronic medications. There are dialysis patients that are losing lives because they cannot have an immediate replacement to three times a week of dialysis sessions.

17:42People who are on a path for their chemotherapy or their cancer treatment is going to be disrupted. Immunization programs are going to be disrupted. So we do as much as we can, but we need to be very clear that the expectations should also be managed in a way that this is not a replacement. It will not replace what a robust, stable health care system can provide for a population. You mentioned that you're working with the government, but there are some regions, Darfork or Dauphin, which have become very restive and some of which the RSF has already taken over. How do you navigate that? We navigate that whether it's in the Sudan scenario, as you mentioned, or other areas within the region and other regions as well, where we have, for example, de facto authorities or we have, you know, conflicting parties.

18:34We make it very clear to all of our entities that we deal with, whether government or not, that we are there for the people. Sometimes we even work with NGOs on the ground to make sure that if we do not have full access, we can work with people who can implement the programs on the ground if we do not have access. In Sudan, for example, we still have access to some of the provinces that are under the RSF. We continue to work with all partners and parties to make sure that if we cannot get in, that at least others. The same thing is in Yemen, for example, and other countries as well. Somalia is the same situation.

19:14Speaking of global funding, if we can go back to that subject, Tom Fletcher, the UN relief chief, recently made a very poignant statement and he says about a billion dollars a day is being spent on war while aid budgets are being cut. Is this now fundamentally about political choices? I truly believe so. I will take you to a realization that is a little bit of a difficult one. This is a very critical statement that Tom has mentioned, and it's a very real one. But on top of that, health usually never gets the attention that it needs. And I think there's a little bit of a lack of realization at the highest political levels that the investment in the health agenda is an investment in the human capital of all of the countries.

20:08And that human capital is what's going to keep the functions, the economy going, decreases the drain of the health sector on the overall budget of the member states. So if countries are going to continue to prioritize investing in wars and military, they will always be losing on the health part. So indeed, that is a painful realization. We've seen countries like the United States take an independent route in how they are going to administer their health aid budgets. The critique has been about the inefficiencies of organizations like yours, from Mr. Trump specifically. I came into the WHO seven years ago.

20:49So I used to be an outsider of the WHO. And maybe this is a difficult thing for me to say in an interview. But when you're an outsider, it is very easy to pick up on inefficiencies. inefficiencies. And it's true. I think any organization has inefficiency. And I really respect what Mr. Trump has said even about inefficiencies in his own country. And that is the eye of someone who's very critical. And I totally agree with that. But the question is, how do we actually fix those inefficiencies? I think the organization, like many organizations, whether they're governmental organizations, which I worked in before, whether the private sector, whether national organizations or international or UN organizations, we all have a lot of work to become more efficient and more effective.

21:40And I think we're on the right path of doing that. We have created more prioritization. We're having more dialogues with our partners. So we are improving. And I hope once the U.S. is back at the table, they will see some major changes in the WHO. So one of the numbers that scared me the most reading up for this interview was that I realized 239 million people across the world are in need of aid, but we only reached 87 million. How do organizations like yours decide who gets the help? We're always asking and thriving and putting those numbers in front of the donors and in front of the emergency appeals that we ask for.

22:20Each of our regions have their own mandates with the member states that we have. and I think it also unfortunately depends on the donors and that's where we go back to sometimes the earmarked funding which is not flexible funding limits us on how we can prioritize. Sometimes the funding comes already prioritized so they say that you're going to have this amount of money to rehabilitate a hospital in this country sometimes in this community so that's where the money is going to go. We have to be very realistic and pragmatic with the resources we have we will never be able to reach these numbers.

22:56I think sometimes the prioritization comes in a way where is the most need when we talk about extreme famine, for example. Prioritization has to go there because people are literally now dying. So we go from the humanitarian aid, from sustaining life to making people thrive. And even within the WHO, we even have a spectrum when we talk about, you know, support that we have for countries. there's countries that we want them to survive and there are countries that need to thrive and there's a spectrum in between and we focus on those who need to survive. To end on a bit more of a positive note, we still have 63 % of Sudan's hospitals working.

23:39What are those moments of resilience that you feel the world should know about in order to give all of us hope? I think the resilience is in the people themselves. I think when I travel to the countries, again, I have 22 countries, I've been to 20 of them. I can talk for hours about the positives, the resilience that the people have. For example, if we talk about Syria, the talent that they have, their agility in wanting to rebuild their systems is absolutely phenomenal. I think in Sudan, I have amazing hope for Sudan. Sudan's prime minister, we had a great discussion, myself and Dr. Tedros in February.

24:15and I was extremely positive about his initiative to bring the Sudanese people together under a malaria elimination initiative that he has launched. This is what makes me excited every morning when I start talking to the member states. I'm extremely energized by the discussions with the Minister of Health in Somalia on how are we going to work with our member states on the pooled procurement initiative that we have with Morocco, something that makes me very positive. The talent as well in looking at how are the member states going to support each other when it comes to training of the health workforce?

24:52How are they going to create seats for each other in their different member states for free training and education? I'm working very closely with both Pakistan and Afghanistan on wild polio eradication. How are the two countries working together on the micro planning for the polio campaigns, for example. There's a lot of examples.

25:18Thank you for listening to The Interview. For more compelling conversations, search for The Interview wherever you get your BBC podcasts. You'll find episodes from entrepreneur Isaac Larian, African politics professor Simukai Chikudu, and campaigner Baroness Armin Kahelik, plus many others. Until next time, bye for now.

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