Johns Hopkins Center for Humanitarian Health–Lancet Commission on health, conflict, and forced displacement : health in a world of crises and impunity

Article Article scientifique Article Johns Hopkins Center for Humanitarian Health–Lancet Commission on health, conflict, and forced displacement : health in a world of crises and impunity eng 2026-05-19 2026-05-23 author Spiegel Paul Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: pbspiegel@jhu.edu. author Martinez Esperanza College of Law, Governance, and Policy, The Australian National University, Canberra, ACT, Australia. author Abrahim Orit Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. author Undie Chi-Chi Baobab Research Programme Consortium, Population Council, Nairobi, Kenya. author Altare Chiara Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. author Schmid Benjamin Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 970189 author Abbara Aula Department of Infectious Diseases, Imperial College London, London, UK. author Bahattab Awsan Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen; Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Novara, Italy. author Bojorquez Ietza Department of Population Studies, El Colegio de La Frontera Norte, Tijuana, Mexico. author Cantor David Refugee Law Initiative, School of Advanced Study, University of London, London, UK. author Jouhaud Rosemary Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 406263 Geneva Centre of Humanitarian Studies (MCERA) Rosemary James author Alier Kemish Kenneth Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. author Maxwell Daniel Feinstein International Center, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MD, USA. author Moya Andres School of Economics, Universidad de los Andes, Bogotá, Colombia. author Ontas Eray Department of Public Health, Ankara University Faculty of Medicine, Istanbul, Türkiye. author Rashid Sabina Faiz BRAC James P Grant School of Public Health and Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC University, Dhaka, Bangladesh. author Rao Malavika Cambridge Centre for Environment, Energy and Natural Resource Governance, University of Cambridge, Cambridge, UK. author Slim Hugo Las Casas Institute for Social Justice, Blackfriars Hall, University of Oxford, Oxford, UK. author Abdelhay Arwa Chemical and Pharmaceutical Engineering Department, School of Applied Medical Sciences, German Jordanian University, Amman, Jordan. author Basaleem Huda Department of Community Medicine and Public Health, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen. author Bisimwa Ghislain Ecole Regionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo. author Fouad Fouad M International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. author Liu Joanne School of Population and Global Health, McGill University, Montreal, QC, Canada; Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada. author Meda Nicolas Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, University of Ouagadougou, Ouagadougou, Burkina Faso. author Pantuliano Sara ODI Global, London, UK. author Zaman Muhammad Center on Forced Displacement, Department of Biomedical Engineering, Boston University, Boston, MA, USA. author Alkhalil Munzer David Nott Foundation Analysis, David Nott Foundation, London, UK; Syria Public Health Network, London, UK. author Falb Kathryn Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. author Holloway Kerrie Humanitarian Policy Group, ODI Global, London, UK. author Jahan Ishrat BRAC James P Grant School of Public Health and Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC University, Dhaka, Bangladesh; Care and Public Health Research Institute, Department of Health, Ethics and Society, Maastricht University, Maastricht, Netherlands. author Kannan Thaenpaavai Fletcher School of Law and Diplomacy, Tufts University, Boston, MA, USA. author Lindsay Helen Center on Forced Displacement, Department of Biomedical Engineering, Boston University, Boston, MA, USA. author Mwene-Batu Pacifique Ecole Regionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo. author Misha Farzana BRAC James P Grant School of Public Health and Climate Change, Environment and Health Hub, BRAC University, Dhaka, Bangladesh. author Bielska Iwona Anna Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. author Modi Koiti Emmily Nasunbga Juba Strategic Consulting, Juba, South Sudan. author Muthuri Stella Baobab Research Programme Consortium, Population Council, Nairobi, Kenya. author Niaoné Moumini Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, University of Ouagadougou, Ouagadougou, Burkina Faso; Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. author Bou-Orm Ibrahim R International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon. author Rodriguez César Department of Health Sciences, Universidad de las Américas Puebla, San Andrés Cholula, Puebla, Mexico. author Sadaf Alina Department of Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. author Saadi Altaf Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. author Polinori Camila Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. author Perrin Franck Caroline 0000-0002-6667-6164 Geneva Digital Health Hub, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 720521 Département de radiologie et informatique médicale (RADIO) author Kampalath Vinay Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA. author Polonsky Jonathan Aaron 0000-0002-8634-4255 Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 888636 Geneva Centre of Humanitarian Studies (MCERA) author Randriambelonoro Mirana Michelle Geneva Digital Health Hub, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 814124 Département de radiologie et informatique médicale (RADIO) author Blanchet Karl 0000-0003-0498-8020 Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 932568 Geneva Centre of Humanitarian Studies (MCERA) 2065-2140 10.1016/S0140-6736(26)00564-7 42155503 0140-6736 https://www.sciencedirect.com/science/article/pii/S0140673626005647 A humanitarian system in failure, and the cost in lives. Both health and human rights are being dismantled globally in plain sight and with escalating impunity, driven by geopolitical fragmentation, erosion of the rule of law, and transactional approaches to aid and security that undermine protection and accountability. Conflict-related deaths nearly doubled between 2021 and 2024, and an estimated 239 million people require humanitarian assistance in 2026. The health systems and humanitarian ecosystem meant to protect health and life are buckling under the scale, duration, and political complexity of contemporary crises. International law and humanitarian principles are increasingly violated with impunity, and civilians are bearing the cost. In 2024, violence against or obstruction of health care reached its highest level on record, with 3663 documented incidents. Protections for civilians, forcibly displaced people, and humanitarian workers are routinely breached. Humanitarian assistance is instrumentalised for political and military ends, access is manipulated as leverage, and health professionals are imprisoned or killed for providing impartial care. Humanitarian needs have outpaced a politicised, fragile, and structurally inadequate funding model. In 2025, the Global Humanitarian Overview was cut mid-year from US$44 billion to $29 billion, with only 55% funded by year's end. For 2026, a downsized and hyperprioritised Overview seeks $33 billion, of which $23 billion is required to meet the most life-threatening needs. For scale, this is equivalent to roughly 1% of annual global military expenditure. The result is rationing by design: assistance reduced from 239 million people in need to 87 million selected for lifesaving assistance. This narrow prioritisation has become a mechanism to legitimise abandonment rather than mitigate harm, reflecting a system deliberately organised around donor control, geopolitical priorities, and the transfer of risk onto civilians. The governance and financing landscape is overtly politicised, with humanitarian and global health funding increasingly shaped by national security and foreign policy priorities rather than humanitarian need. Donor withdrawals, budget cuts, and tightly conditioned funding have further recast humanitarian and public health financing as statecraft. A system governed in this way will not self-correct: exclusion becomes normalised, accountability is reduced to compliance, and humanitarian health becomes increasingly selective and unreliable, with large-scale need left outside response plans. The consequences for population health are immediate and cumulative. In conflict and displacement settings, excess mortality is driven less by direct violence than by the breakdown of essential health services, public health functions, and the social determinants of health. Disruptions to vaccination, primary care, maternal and newborn services, and to the continuity of care for chronic conditions turn manageable illness into preventable disability and death. [...] Un système humanitaire en échec qui coûte des vies humaines. La santé et les droits humains sont tous deux en train d’être démantelés à l’échelle mondiale, au vu et au su de tous, avec une impunité croissante. Cette dynamique est alimentée par la fragmentation géopolitique, l’érosion de l’État de droit et des approches transactionnelles de l’aide et de la sécurité qui sapent la protection et la responsabilité. Les décès liés aux conflits ont presque doublé entre 2021 et 2024 et environ 239 millions de personnes auront besoin d’une assistance humanitaire en 2026. Les systèmes de santé et l’écosystème humanitaire censés protéger la santé et la vie ploient sous l’ampleur, la durée et la complexité politique des crises contemporaines. Le droit international et les principes humanitaires sont de plus en plus violés dans l’impunité et les populations civiles en paient le prix. En 2024, la violence contre les soins de santé ou leur entrave ont atteint leur niveau le plus élevé jamais enregistré, avec 3 663 incidents documentés. Les protections accordées aux civils, aux personnes déplacées de force et aux travailleurs humanitaires sont régulièrement bafouées. L’assistance humanitaire est instrumentalisée à des fins politiques et militaires, l’accès est manipulé comme levier de pression, et des professionnels de santé sont emprisonnés ou tués pour avoir dispensé des soins de façon impartiale. Les besoins humanitaires non couverts ont mis en lumière un modèle de financement politisé, fragile et structurellement inadéquat. En 2025, la contribution humanitaire mondiale a été réduite en cours d’année, passant de 44 milliards de dollars à 29 milliards de dollars, avec seulement 55 % du financement obtenu à la fin de l’année. Pour 2026, un récapitulatif réduit et hyper-priorisé nécessite 33 milliards de dollars dont 23 sont nécessaires pour répondre aux besoins les plus vitaux. À titre de comparaison, cela équivaut à environ 1% des dépenses militaires mondiales annuelles. Le résultat est un rationnement par contrainte: l’assistance passe de 239 millions de personnes dans le besoin à 87 millions, sélectionnées pour leur besoin en aide vitale. Cette priorisation drastique est devenue un mécanisme qui légitime l’abandon plutôt qu’elle n’atténue les préjudices, reflétant un système délibérément organisé autour du contrôle par les bailleurs, des priorités géopolitiques et du transfert du risque vers les populations civiles. Le paysage de la gouvernance et du financement est ouvertement politisé, les financements humanitaires et de santé mondiale étant de plus en plus façonnés par les priorités de sécurité nationale et de politique étrangère plutôt que par les besoins humanitaires. Les retraits de bailleurs, les coupes budgétaires et les financements strictement conditionnés ont encore davantage transformé le financement humanitaire et de santé publique en instrument de politique étatique. Un système gouverné de cette manière ne se corrigera pas de lui-même : l’exclusion se normalisera, la responsabilité se réduira à la conformité et la santé humanitaire deviendra de plus en plus sélective et peu fiable tandis que des besoins de grande ampleur resteront en dehors des plans de prise en charge. [...] Altruism Armed Conflicts / statistics & numerical data Global Health / economics Global Health / statistics & numerical data Human Rights Humans Internationality Intersectoral Collaboration Politics Refugees / statistics & numerical data Relief Work / economics Relief Work / organization & administration Dewey 613 216 Centre d’études humanitaires Genève 22A8 false 178 Groupe Geissbuhler Antoine (informatique médicale) 222 Lancet 407 10543 9ffadee8-7a42-4ba7-984d-d0965a08acd4 Article (Published version) Restricted PIIS0140673626005647.pdf 6227933 application/pdf 0b1b5433aa5ca2381c0a3de5def568fc53cb9fccb327b4141c9382430113e2ca bbfe4149-0365-4ba0-b046-0c4df7e18cde Supplemental data Restricted 1-s2.0-S0140673626005647-mmc1.pdf 141673 application/pdf French summary 2d1bdaec148815b02c0f6a37ea59de989ca59b13a03e70387d35bc5787852604 1e17b27c-b5b8-4222-809d-047894fe6a33 Supplemental data Restricted 1-s2.0-S0140673626005647-mmc2.pdf 158488 application/pdf Spanish summary ae6c7db06fa5072b2b41c0e90804d530920363db0e4d2e617769c3122b8caf75 ef7a7713-9630-4086-b7e0-bc83d8ee2154 Supplemental data Restricted 1-s2.0-S0140673626005647-mmc3.pdf 278099 application/pdf Arabic summary 1a0f16ce7071581ee64b986c3ddf965a87ece5fe73186cd668e128af30bc326e 9bb328a1-554d-403e-9d2c-0d5e5a29c0db Supplemental data Restricted 1-s2.0-S0140673626005647-mmc4.pdf 1187541 application/pdf c056c1d236a26488846c445b802ad5b606a07111b832893cceacd57319a48599 restrictedAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Centre d’études humanitaires Genève

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Johns Hopkins Center for Humanitarian Health–Lancet Commission on health, conflict, and forced displacement : health in a world of crises and impunity	Lancet			2026	7	0

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Schmid, Benjamin