Public Health Citizenship in a Wounded World

The World Federation of Public Health Associations (WFPHA) convenes Global Public Health Week (GPHW) to mark the entry into force of the WHO Constitution, one of the UN Treaty Collection treaties, on April 7th, 1948. This year, GPHW could hardly have come at a more urgent moment, as war, displacement, climate breakdown, and political intimidation, once again demonstrate how fragile the systems on which global public health is built.

Beyond “Polycrisis”: Interlocking Global Threats to Public Health

Although referred to in the WFPHA–GNAPH GPHW seminar on “Geopolitics and Public Health” as polycrises, more accurately, these are not a series of crises (which are, by definition, limited to events) but are much more complex than that. Conflict, forced migration, environmental catastrophe, economic instability, and disinformation are not separate emergencies but interlocking assaults on life, dignity, knowledge, and the systems that they protect.

The Public Health Impact of War and Displacement

For us, the public health implications are both immediate and long-term. War kills and maims far beyond the battlefield, destroying civic infrastructure, including water systems, transport and communication systems, safe housing, supply chains, and access to basic necessities such as food, health services, education, housing, imposing a massive toll on psychological health and wellbeing. 

War overwhelms and displaces civilians, most of whom are not sheltered by wealthy countries and wealthy people but are left internally displaced in camps, border zones, and fragile transit settings. War turns infectious diseases into epidemics, chronic diseases into crises, and trauma into a generational inheritance. War especially affects the health of women and children, who are usually absent from negotiation tables and routinely ignored. We can see that massive efforts are expended on war, but little thought is given to winning peace.

Public Health Ethics, Truth, and the Role of Journalism

To address these problems, public health work in the spheres of humanitarian aid and crisis response must remain fact- and evidence-based and impartial. But impartial does not mean passive. Truthfully reporting current events is essential in wartime as in every other time. Good journalism is itself a public health good, because when truth is weakened, violence becomes easier to justify and harder to stop. Neutrality is not the same as silence.

Global Threats to Public Health Systems and Institutions

Today’s battles are worldwide assaults on the public’s health, some driven by armed conflict but others by climate disaster, information catastrophe, oligarchic power, and the corrosion of global institutions. Public health cannot remain reactive, timid, and fragmented, but needs solid risk preparedness, stronger international bodies, alongside a renewed ethic of service and equality. Very few of our political leaders are even vaguely prepared for polycrisis, and a lack of planning for prevention and preparation for response to limit the inevitable impact of disasters increases risk to people and environments. 

Science is distorted and distrusted; experts are disdained. Influencers’ opinions receive more public attention than those of public health practitioners, despite the latter’s extended education and training. Public health institutions and professionals face an existential threat (see current government activities in the USA, for example) because the instant voices of modern populism are ranged against considered ideas of public service, vocation, and professionalism.

Public Health Ethics Matter in Times of Crisis

Public health ethics matter because public health is not only about disease prevention. It is also about conflict prevention. It is also about the conditions in which people can live with security in dignity, whether families can stay safe, whether children can thrive, whether truth can still be spoken, and whether vulnerability is protected by institutions. It is about refusing to accept that cruelty, corruption, and authoritarianism are simply the way the world now works.

Public Health Citizenship: Responsibility in a Time of Crisis

The lesson of these frightening days is not to despair but to take on responsibility. Public health applies to everyone, so all citizens have a role to play in resisting all the forces that make populations sick and societies cruel. We need stronger systems thinking, the courage to voice the truth plainly and with evidence, better training on the health consequences of war, public health approaches in peacebuilding, and broader inclusion at decision-making tables. Public health education and training must include political literacy, strategic communication, systems thinking, and ethical negotiation, key competencies recognized by WHO. 

This is a time for collective solidarity, not isolation; for courage, not resignation; for moral clarity, not detachment. Public health is often treated as a technical field. Yes, it is. But it is also a political one: health, especially public health, is a political choice. The public health community must say, and mean, that there is no health without peace, no peace without justice, and no justice without the courage to resist tyranny.

A Collective Civic Task for the Future of Public Health

We generate evidence for health. So, collectively, this is our space and our civic task. The need for preparedness is a public health issue that we must address. To repeatedly tell truth to power, choose solidarity over surrender, and refuse to be silenced, with courage.

Acknowledgements

We gratefully acknowledge the contribution of ideas from our seminar speakers and moderator: Bettina Borisch, Mary Codd, Chuck Johnson, Duha Shellah, Melissa Sweet, and Michael Moore.

Bibliography

• Borisch B, Lomazzi M. Should we still talk about the crisis? Journal of Public Health Policy, Federation’s Pages. Published online 16 March 2023. 
• National workforce capacity for essential public health functions: a Roadmap. WHO, 2024. 
• Middleton J. GNAPH president’s blog, The war on the public’s health. GNAPH, March 10th 2026.
• The link between geopolitics and public health: a WFPHA / GNAPH webinar.

Global Sumud Flotilla: Background, Mission, and Public Health Significance

The Global Sumud Flotilla has become one of the most widely discussed civilian solidarity initiatives linked to the humanitarian crisis in Gaza.

For public health organizations, the issue extends beyond maritime activism. It addresses access to healthcare, food, medicine, and clean water, civilian protection, and the obligations of states under international humanitarian law.

Let’s explore what the Global Sumud Flotilla is, why it began, what previous Gaza flotillas have sought to achieve, and what happened during the previous missions.

What Is the Global Sumud Flotilla?

The Global Sumud Flotilla is an international, civilian-led maritime initiative organized to draw attention to the humanitarian conditions in Gaza and to call for the safe delivery of humanitarian assistance.

The word “sumud” refers to steadfastness or resilience.

Organizers describe the flotilla as a nonviolent civilian mission intended to highlight the impact of Israel’s siege conditions, restrictions on humanitarian access, and the deterioration of living conditions faced by Palestinian civilians. In 2025, the flotilla brought together more than 40 vessels and participants from over 40 countries, making it one of the largest flotilla mobilizations in recent years.

Why Did the Global Sumud Flotilla Begin?

The flotilla emerged in response to the escalating humanitarian emergency in Gaza.

Hospitals and health facilities have faced repeated disruption, while shortages of medicines, fuel, food, and clean water have intensified the public health crisis.

Organizers have framed the initiative around several urgent concerns:

• restricted humanitarian access to civilians;
• the collapse or interruption of essential health services;
• widespread displacement;
• growing international concern over the protection of civilians during armed conflict.

The flotilla’s stated objective has been to draw international attention to these conditions while affirming principles of human dignity, civilian protection, solidarity, and international law.

Earlier Gaza Flotillas: Historical Context

The Global Sumud Flotilla is part of a longer history of civilian maritime initiatives linked to Gaza.

2010 Gaza Freedom Flotilla

The most widely known precedent remains the 2010 Gaza Freedom Flotilla, when Israeli forces intercepted several Gaza-bound vessels in international waters.

That event prompted global debate about:

• maritime interception;
• humanitarian access;
• civilian protection;
• the legal implications of blockade enforcement.

Subsequent Flotilla Efforts

In the years that followed, several additional flotillas sought to deliver aid or symbolically challenge restrictions on access to Gaza.

Most did not reach Gaza, but they kept international attention focused on:

• humanitarian access;
• civilian suffering;
• legal accountability;
• international humanitarian law.

The Global Sumud Flotilla emerged from this broader tradition of civilian international solidarity.

What Happened During the 2025 Global Sumud Flotilla?

The 2025 Global Sumud Flotilla was the largest mission associated with the initiative to date.

Launch of the flotilla

The mission began in late August and September 2025, with vessels departing from ports in Spain, Tunisia, Italy, and Greece.

According to organizers, the flotilla included 42 boats and 462 participants from more than 40 countries. The most notable participant was Greta Thunberg. 

Reported disruptions at sea

During the voyage, participants reported a series of disruptions by Israel, including:

• surveillance;
• delays;
• communication interference;
• drone-related attacks affecting several vessels.

Interception in October 2025

By early October 2025, Israeli forces had intercepted the flotilla before it could reach Gaza.

Reports indicate that multiple participants were detained, tortured, and later deported by Israel. The flotilla did not reach its intended destination, but the mission generated renewed global attention to humanitarian access and civilian protection.

Public Health and Humanitarian Access in Gaza

For the public health community, the humanitarian crisis in Gaza is inseparable from access to lifesaving assistance.

Restrictions on humanitarian access directly affect:

Healthcare delivery

Hospitals and clinics depend on reliable access to medicines, fuel, surgical supplies, and emergency equipment.

Maternal and child health

Interruptions to health services place pregnant women, newborns, and children at particular risk.

Disease prevention

Shortages of clean water, sanitation services, and access to vaccination increase the risk of communicable disease outbreaks.

Nutrition and food security

When food access is restricted, acute malnutrition and long-term health consequences can rapidly intensify.

From a public health perspective, humanitarian access is therefore not simply a logistical issue; it is central to the protection of life and health.

Statement in Support of the Global Sumud Flotilla

The World Federation of Public Health Associations (WFPHA) recognizes the promotion of peace as a central part of its mission, understanding peace as a fundamental determinant of health.

In this context, the ongoing conflict in Gaza remains a matter of deep concern for the Federation.

On September 12, 2025, the WFPHA issued a call for global action in response to the escalating public health crisis in Gaza.

In alignment with this commitment, the WFPHA expresses its support for the Global Sumud Flotilla as a peaceful civilian initiative grounded in human dignity, solidarity, and international law.

The flotilla represents a collective effort to draw international attention to the severe humanitarian conditions faced by Palestinians, particularly in Gaza.

The WFPHA also calls for the safety and protection of all individuals participating in the flotilla, including Juan Garay, coordinator of the Sustainable Health Equity Movement, an organization for which the WFPHA is a founding partner.

The Federation further urges all parties to:

• uphold international humanitarian law;
• ensure the protection of civilians;
• create conditions for the safe, rapid, and unimpeded delivery of humanitarian assistance.

The Global Sumud Flotilla in 2026

In 2026, the Global Sumud Flotilla again became the focus of international concern after Israeli forces intercepted 22 civilian vessels in international waters near Greece and detained approximately 175 crew members and activists participating in the mission. The flotilla had sought to challenge Israel’s blockade of Gaza and deliver humanitarian supplies, including food, infant formula, and medical aid, to civilians facing catastrophic humanitarian conditions.

According to Amnesty International, communication channels were jammed during the interception, raising immediate concerns for the safety of those on board. The organization also called for the immediate and unconditional release of those detained, citing documented allegations of ill-treatment during previous flotilla interceptions in October 2025. For public health and humanitarian actors, the 2026 interception has renewed urgent concern about the protection of civilians, the treatment of humanitarian missions, and the obligation under international humanitarian law to ensure safe, rapid, and unimpeded humanitarian access for the population of Gaza.

A Global Priority

The Global Sumud Flotilla has become a significant civilian initiative at the intersection of humanitarian advocacy, international law, and public health.

For health organizations and public health professionals, the central issue remains clear: protecting civilian life and the safe delivery of humanitarian assistance must remain a global priority.

 

Read the official statement here.

Protecting Indigenous Children from Sugary Drinks and Food Marketing Across the Pacific

The terms Pacific peoples, Pacific Islanders, Pasifika, Asian/Pacific Islanders, and Native Hawaiian and Other Pacific Islanders refer to communities from more than 16 nations across Polynesia, Micronesia, and Melanesia. Pacific Island Countries and Territories (PICTs) encompass around 25,000 islands and more than 3.2 million people.

Despite their cultural and political diversity, these nations share common challenges. Geographic isolation, colonial legacies, and rapidly changing food systems have reshaped health outcomes across the region. The South Pacific includes Indigenous Melanesian, Micronesian, and Polynesian populations, as well as migrants from Asia and Europe. Collectively, Indigenous residents and diaspora communities are often referred to as Pacific peoples.

Across the Pacific, Indigenous children experience disproportionately high rates of dental caries compared with non-Indigenous populations, reflecting broader structural health inequities. Addressing these disparities requires confronting both the commercial forces shaping children’s diets and the policy environments that allow them to persist.

The Oral Health Crisis Facing Pacific Children

Evidence across the region highlights the scale of the challenge. In some Pacific communities, tooth decay affects nearly all children, making it one of the most widespread childhood health conditions.

Research indicates:

• Up to 100% of Pacific children in some communities experience tooth decay.
• In Australia, decay affects 52–77% of primary teeth and 36–60% of permanent teeth among children.
• In the Solomon Islands, the mean dmft score is 4.8 among six-year-olds, with only 16.9% of children caries-free.
• In Tonga, over 50% of children have untreated tooth decay.
• Vanuatu and Fiji report caries rates ranging from 44% to nearly 100%.
• In Aotearoa New Zealand, 40–50% of five-year-olds experience tooth decay, with Māori and Pacific children disproportionately affected.

These figures illustrate not only a widespread oral health crisis but also a clear pattern of inequity affecting Indigenous children across the Pacific region.

The Commercial Determinants of Children’s Diets

Understanding why Pacific children face such high rates of tooth decay requires examining the commercial determinants of health, the systems and practices through which industries influence health outcomes.

The Pacific Community (SPC) MANA (Monitoring and Analysis of Nutrition Activities) Dashboard shows that while some Pacific Island countries have introduced fiscal measures such as sugar-sweetened beverage taxes, comprehensive policies restricting the marketing of unhealthy foods and drinks to children remain limited.

Key policy challenges include:

• Reliance on voluntary industry codes rather than binding regulations
• Weak or inconsistent enforcement mechanisms
• Limited monitoring of digital marketing and social media advertising

As a result, children across the Pacific are routinely exposed to aggressive marketing of ultra-processed foods and sugar-sweetened beverages through television, point-of-sale promotions, sponsorships, and digital platforms.

This marketing environment reinforces unhealthy dietary patterns and contributes directly to the region’s growing burden of diet-related diseases and oral health problems.

Structural Inequities and Colonial Legacies

The persistence of poor oral health outcomes cannot be separated from the region’s historical and structural context.

Many Pacific Island countries continue to navigate the impacts of:

• Colonial economic and political systems
• Imported food supply chains are replacing traditional diets
• Limited access to preventive oral health services
• Workforce shortages in dentistry and oral health care

These structural factors intersect with commercial marketing pressures, creating environments where healthy choices are often harder for families to access and sustain.

Strengthening Indigenous Voices and Leadership

Lasting solutions require centering Indigenous perspectives in health policy, research, and advocacy.

Prioritizing Indigenous knowledge and community leadership can help ensure that policies addressing food marketing and children’s diets are culturally grounded, locally relevant, and effective.

Key priorities include:

Community Leadership in Policy Development

Active participation from Indigenous communities ensures that regulations addressing unhealthy food marketing reflect local values, cultural practices, and lived realities.

Collaboration and Research Capacity

Investing in Pacific-led research and oral health workforce development strengthens the evidence base while supporting community-driven prevention strategies and service delivery.

Cross-Indigenous Partnerships

Collaboration among Indigenous communities across the Pacific and globally can strengthen advocacy efforts, share best practices, and build momentum toward equitable food environments for children.

A Path Forward for Pacific Children’s Health

Protecting Indigenous children from harmful food and beverage marketing is an essential step toward improving oral health equity across the Pacific.

This means:

• Implementing strong statutory restrictions on marketing unhealthy foods to children
• Strengthening monitoring and enforcement systems
• Investing in community-led oral health programs
• Supporting Indigenous leadership in research and policy development

By amplifying Indigenous voices and addressing the structural drivers of unhealthy food environments, Pacific communities can develop locally led, culturally grounded, and transformative solutions that safeguard the health of future generations.

Ensuring healthier food environments today is critical for protecting the smiles, well-being, and futures of Pacific children tomorrow.

Written by Seema Lal, Vice Chair of the Oral Health Working Group, and Working Group member Sefali Koirala.

Honoring and Remembering Dr. María del Rocío Sáenz Madrigal

On behalf of the World Federation of Public Health Associations, we come together to honor and remember María del Rocío Sáenz Madrigal, an extraordinary physician, public health leader, educator, and steadfast advocate for equity whose life and work have left an indelible mark on Costa Rica, Latin America, and the global public health community.

Born on May 2, 1958, and passing away on March 15, 2026, in Puriscal, Costa Rica, Rocío dedicated her life to serving others. She trained as a medical doctor at the Universidad La Salle in Mexico and furthered her expertise with a Master’s in Public Health from the University of Costa Rica. From her earliest days assisting patients with chronic conditions, and serving as medical director of a refugee camp for Nicaraguans, director of Health Development for the Ministry of Public Health of Costa Rica, and the Pan American Health Organization (PAHO)’s Regional Advisor for the Central America Post-Mitch Program, she demonstrated a profound commitment to the most vulnerable, ensuring that health was not an abstract ideal, but a lived reality for all.

Her leadership shaped national systems and inspired international collaboration. As Minister of Health of Costa Rica from 2002 to 2006, and later as Executive President of the Costa Rican Social Security Fund from 2014 to 2017, Rocío guided transformative efforts grounded in equity, access, and human dignity. Her influence extended far beyond national borders through her work with PAHO, her role in health emergency response, and her leadership as director of the Health Equity Network of the Americas / Red de las Américas para la Equidad en Salud (HENA/RAES), based at the University of Costa Rica.

Rocío was also a devoted academic and mentor. As Professor of Health Promotion at the University of Costa Rica, she nurtured generations of public health professionals, led critical research initiatives, and advanced dialogue on primary health care, women’s health, and patient-centered systems. Her contributions, reflected in dozens of technical and scientific publications, continue to inform and inspire.

For the World Federation of Public Health Associations, Rocío was more than a collaborator. She was a trusted partner, an active contributor, and a guiding force. Through her engagement with our Working Groups and global initiatives, she brought clarity, wisdom, and a deep moral compass. She strengthened our collective mission and reminded us always of the human stories behind the policies we shape.

Her impact is perhaps best captured in the words of those who knew her closely.

Luis Eugenio de Souza, immediate Past President of the WFPHA, said:

“Dr. Rocio was a true leader in Costa Rica, Latin America, and the world, a highly competent and ethical professional who will continue to inspire public health professionals.”

Our President, Emma Rawson Te-Patu, shared:

“María del Rocío Sáenz was a force of nature. Her clarity of mind and strategic understanding of, and how to speak about, what should be addressed as a priority for equity, human rights, and effective health systems, health service delivery, and policy development was extraordinary. She was a true example of leadership and of empowering others to act for the greater good. Rocio could hold a room in the palm of her hand with her tone, a look, and indeed a few specific hand gestures that left you in no uncertain terms that you had been informed and must act. I was privileged to spend much time with and to learn and be guided by Rocio. I especially treasure the time we were together as Salzburg Global Fellows in Salzburg, Austria, in 2024 and more recently in Brasilia, Brazil, at Abrasco in November 2025. She will be missed by many, by our public health family and the global community at large. Tenei te mihi ki a koe e te Mareikura, Haere Haere Haere atu rā, Kua Wheturangitia! Arohanui ki te whānau pani… (We acknowledge you, leader of people, you are now part of the cloak of stars in the sky. Go now, rest now, be at peace. Sending love to your family and loved ones).”

Bettina Borisch, our CEO, adds:

“For all of us who had the privilege of working with Maria del Rocio Saenz, we got to know an exceptional human being, kindness and determination, knowledge and humanity, so many more combinations rarely found in one person: Rocio, we already miss you!”

Arachu Castro, Professor and Samuel Z. Stone Chair of Public Health in Latin America at Tulane University and member of the board of directors of the Health Equity Network of the Americas, wrote: 

“Rocío was an extraordinary woman who led with conviction, compassion, and integrity in the pursuit of health equity across Latin America. I had the privilege of working closely with her over the past seven years and of calling her a dear friend and a mentor. She was deeply inspiring and thoughtful in all that she did. In recent years, as director of HENA/RAES, Rocío built a vibrant technical secretariat at the University of Costa Rica composed of public health graduates, creating opportunities for young people to learn, grow, and thrive. She was committed to nurturing the next generation with care and intention. At our most recent HENA monthly meeting, two days before her passing, she shared her intention to transfer the directorship to a member of the technical secretariat, reflecting her commitment to continuity and collective growth, as well as her generosity. Through our regular conversations, she remained a constant source of clarity and inspiration. Her absence will be profoundly felt. I will miss her dearly.”

Michael Moore, Past President of the WFPHA and Chair of the Immunization Taskforce, shared:

“Not only has Costa Rica lost a great public health professional, but the world has as well. She was not only an outstanding professional but also a person full of compassion and humanity. We mourn the loss of María del Rocío Sáenz Madriga, a great friend to the World Federation of Public Health Associations for her commitment and expertise. She brought a unique blend of political experience and medical expertise to the Federation’s policy and advocacy work. The thoughtful and professional approach she applied in discussions and during WFPHA webinars provided clear insight into both the challenges and solutions regarding public health issues. Her premature death is particularly sad for those of us who understand the contribution that she has made, and should be continuing to make, to improve health across the life course and independent of wealth.”

And our Past President, Walter Ricciardi, added:

“Dr. Rocío Sáenz will be remembered for her unwavering dedication to public health, her compassion for others, and the lasting impact she made on so many lives—an impact I had the opportunity to witness firsthand through our work together in the Public Health Leadership Coalition of the World Federation of Public Health Associations, where she was one of the most active and respected leaders leaving behind a legacy that will continue to inspire future generations in the pursuit of equity and health for all.”

These words reflect what so many of us feel: that Rocío was not only brilliant, but deeply human. She led with conviction, spoke with purpose, and acted with compassion. She had the rare ability to challenge, to inspire, and to unite; always in the pursuit of a fairer, healthier world.

We mourn her passing, but we also celebrate her legacy. A legacy of courage, of integrity, and of unwavering commitment to health as a fundamental human right. A legacy that lives on in the systems she strengthened, the people she mentored, and the global movement she helped shape.

On behalf of the World Federation of Public Health Associations, we extend our deepest condolences to her family, her colleagues, and all who had the privilege of knowing her.

Rocío, thank you for your leadership, your wisdom, and your friendship. Your work continues through all of us.

 

 

Oral Health in Humanitarian Crises: A Missing Link in Refugee Health and Peacebuilding

Four in five Rohingya refugees seeking dental care in Cox’s Bazar report pain, and nearly half describe their oral health as “poor.” Similar patterns have been documented among refugee populations worldwide.

Oral health is a recognized component of overall health. Yet in humanitarian crises, it remains largely absent from emergency response frameworks. In contexts of conflict and forced displacement, oral healthcare infrastructure is often damaged, disrupted, or inaccessible.

Untreated oral disease is associated with cardiovascular conditions, diabetes complications, and adverse pregnancy outcomes, conditions already more prevalent in crisis-affected populations. Despite this, refugee dental care rarely appears in Emergency Health Minimum Service Packages.

As of 2024, more than 122 million people worldwide were forcibly displaced, including 43.7 million refugees. The burden of untreated oral disease among these populations is substantial and largely unaddressed.

The Global Burden of Oral Disease Among Refugees

Displaced populations are concentrated in:

• Africa: Sudan, South Sudan, Democratic Republic of the Congo, Somalia, Ethiopia, Nigeria
• Middle East: Syria, Yemen, Iraq, Palestine
• Europe: Ukraine
• Latin America: Venezuela, Colombia
• Asia: Afghanistan, Myanmar, Cambodia

Evidence shows consistently high levels of unmet oral health needs:

• In Canada, 85% of adult refugees have untreated dental decay, compared with 20% in the general population.
• In Massachusetts, refugee children have twice the rate of untreated dental caries as the national average.
• A global scoping review reported caries prevalence among refugees ranging from 5% to 99%, and gingivitis from 6% to 100%, reflecting wide but consistently high unmet need.

These figures reveal a persistent gap in humanitarian healthcare planning: oral health is treated as optional rather than essential.

Why Oral Health Is Excluded From Humanitarian Health Packages

Even in stable health systems, oral health is often separated from general healthcare. In crisis settings, where resources are stretched, and life-threatening conditions take precedence, this marginalization deepens.

Humanitarian responses prioritize:

• Food
• Shelter
• Water and sanitation
• Essential medical care

Oral health rarely features in Emergency Health Minimum Service Packages. A recent content analysis found little to no integration of oral health within refugee health policy frameworks.

Three factors contribute to this exclusion:

1. The “Non-Life-Saving” Misconception

Oral health is frequently categorized as non-essential. Yet severe dental infections can progress to sepsis, and unmanaged pain disrupts eating, sleeping, and daily functioning.

2. The Infrastructure Myth

Dental care is perceived as requiring specialist equipment and facilities. In reality, many urgent needs, including pain management, infection control, and simple extractions, can be addressed with basic equipment and trained health workers.

3. The Data Gap

Oral health indicators are rarely included in rapid health assessments. Without data on pain prevalence, untreated infection, or functional impairment, the burden remains invisible in planning and resource allocation.

The exclusion reflects how humanitarian systems define and prioritize health interventions, not the absence of need.

Health System Consequences in Conflict Settings

The omission of oral health has measurable consequences and aligns directly with the Global Public Health Week 2026 theme: “Peace for Health, Health for Peace.”

Emergency departments frequently see patients presenting with oral pain but lack the capacity to provide definitive treatment.

In Gaza by mid-2024, only 60 of approximately 1,500 licensed dentists were able to provide care, illustrating the collapse of oral health service capacity during the prolonged conflict.

Untreated oral disease restricts:

• Food intake
• Communication
• Social participation

In conflict-affected settings, social determinants such as housing, food security, and sanitation already heighten health risks. When treatable conditions remain unaddressed, trust in health systems declines.

Oral health influences nutrition, psychological well-being, and economic participation. Functional impairment caused by oral disease can slow community recovery and undermine longer-term peacebuilding efforts.

Oral health, dignity, and peace are interconnected.

Evidence That Integration Is Feasible

Multiple programs demonstrate that integrating oral health into humanitarian responses is feasible and effective.

The Refugee Crisis Foundation (RCF) operates in Cox’s Bazar, Bangladesh, home to nearly one million Rohingya refugees. RCF provides:

• Fixed and mobile dental services
• School-based prevention programmes
• Training for local health workers to manage oral emergencies

RCF also supports initiatives in Gaza and on the Greek island of Lesbos.

Comparable models exist elsewhere:

• In Brazil, NGO-public health partnerships provide fluoride varnish and sealants to Venezuelan and Haitian refugees.
• In Bangladesh, culturally adapted oral health education programs have improved hygiene practices among Rohingya communities.
• In Ukraine and New Zealand, oral health has been incorporated into emergency response and resettlement frameworks.

These examples demonstrate that success depends less on specialist infrastructure and more on integration with primary care, education, and community health platforms.

Practical Actions to Integrate Oral Health Into Humanitarian Response

To ensure refugee dental care is treated as essential healthcare, several actions are needed:

1. Include Oral Health in Emergency Health Minimum Service Packages

Baseline services should include:

• Pain relief
• Infection control
• Referral pathways
• Distribution of oral hygiene supplies

Standard-setting bodies such as the Sphere Association and UNHCR should incorporate this into their policy guidance.

2. Expand the Role of Community Health Workers

Task-sharing can extend access where dentists are unavailable. Training should include recognizing oral emergencies, performing basic interventions, and outlining referral pathways.

3. Collect Oral Health Data in Rapid Assessments

Indicators related to pain prevalence, untreated infection, and functional impairment should inform planning and funding decisions.

4. Integrate With Existing Health Platforms

Oral health can be embedded within:

• Maternal and child health services
• Non-communicable disease programs
• Primary healthcare systems

5. Reframe the Narrative

Urgent oral conditions must be recognised as essential medical needs rather than elective services.

Conclusion: Oral Health Is Essential in Humanitarian Crises

Oral health remains underrepresented in humanitarian policy and practice. Yet evidence shows that low-cost interventions, including daily oral hygiene support, access to fluoride, and emergency pain management, are feasible and effective.

Integrating oral health into humanitarian health frameworks aligns with commitments to:

• Equity
• Universal health coverage
• Health system resilience
• Peacebuilding

Oral health should be a standard component of humanitarian health responses, not an afterthought.

Written by the Chair of the WFPHA Oral Health Working Group, Abiola Adeniyi, and Working Group member Aya El Tahir