Towards a global health practice based on the liberation and sovereignty of populations under siege: a theoretical analysis

Abstract

BackgroundThe 1990s were dubbed the sanctions decade, typified by the situation in Iraq. The past 10 years have seen continued use of siege, ostensibly in the interest of promoting political change. For this decade, the Gaza Strip has been the model of siege. Siege regimes have also been imposed on Yemen, and to a lesser extent on Qatar, Iran, and areas of Syria. This paper examines the consequences of siege for those in the field of health-care provision, and what responsibilities medical staff have in the face of the human rights crises that accompany siege. Can public health needs be served without an explicit agenda that promotes sovereignty and liberation of populations under siege? MethodsThe primary source of data for this paper is secondary literature, popular media and non-governmental organisation (NGO) reports dealing with the effects of siege on health-care provision in Gaza, Yemen, Iraq during the Sanctions period, and Iran. These primary data are supported by participant observation and interviews with medical staff in the Gaza Strip. These data were analysed using a critical political economy framework. Ethics approval was obtained from the Institutional Review Board of Bucknell University. FindingsSiege continues to be promoted as an alternative to warfare in the press and in academic writing. Medical and other NGOs document the strain that blockades represent as they record the extent of health-care crises, but they do not confront the coalitions that impose siege. Discussions of the importance of sovereignty to the promotion of health care remain sidelined within a discourse of wars on terror. InterpretationFamiliarity and engagement with geopolitical practices of isolation and resistance is important for health-care providers in territories under siege. As health-care providers represent front line witnesses of the effects of siege on local populations, their testimonies represent a substantial challenge to the status quo. International and local health workers should coordinate with activists and academics to create a global health paradigm of liberation by promoting local sovereignty and international solidarity. FundingBucknell University.