The governance gap: Determinants of health, international humanitarian law violations, and the case for health diplomacy

Twelve years after the Lancet-Oslo University Commission on Global Governance for Health [2] global governance frameworks for protecting health in conflict continue to be treated as separate humanitarian, geopolitical, and security issues rather than an integrated part of everyday public health governance. We sit in a time of record attacks on healthcare and severe consequences of armed conflict. In 2024, over 3,600 attacks on healthcare were recorded globally, a 15% increase from 2023, and 62% increase from 2022 [3]. In 2024, over 900 healthcare workers were killed, 470 detained, and 140 kidnapped, and more than 1,100 health facilities were destroyed amid systematic obstruction of ambulances and humanitarian access [4]. In the last year fatal attacks on humanitarian personnel were reported in the Democratic Republic of Congo, Gaza and the West Bank, Lebanon, Myanmar, South Sudan, Sudan, and Ukraine [4]. Global governance for health must explicitly govern the political, commercial, environmental, and epistemic determinants of health at an institutional level and governance to protect life in conflict should be part of routine public health governance discourse, with health diplomacy responding more directly to upstream drivers of health impacts and health system collapse, and IHL violations.