Category Archives: Right to health

U.S. and EU Sanctions Are Punishing Ordinary Syrians and Crippling Aid Work, U.N. Report Reveals

U.S. and EU Sanctions Are Punishing Ordinary Syrians and Crippling Aid Work, U.N. Report Reveals

Dania Khalek,  The Intercept,  28 September 2016

Internal United Nations assessments obtained by The Intercept reveal that U.S. and European sanctions are punishing ordinary Syrians and crippling aid work during the largest humanitarian emergency since World War II.

The sanctions and war have destabilized every sector of Syria’s economy, transforming a once self-sufficient country into an aid-dependent nation. But aid is hard to come by, with sanctions blocking access to blood safety equipment, medicines, medical devices, food, fuel, water pumps, spare parts for power plants, and more.

In a 40-page internal assessment commissioned to analyze the humanitarian impact of the sanctions, the U.N. describes the U.S. and EU measures as “some of the most complicated and far-reaching sanctions regimes ever imposed.” Detailing a complex system of “unpredictable and time-consuming” financial restrictions and licensing requirements, the report finds that U.S. sanctions are exceptionally harsh “regarding provision of humanitarian aid.”

U.S. sanctions on Syrian banks have made the transfer of funds into the country nearly impossible. Even when a transaction is legal, banks are reluctant to process funds related to Syria for risk of incurring violation fees. This has given rise to an unofficial and unregulated network of money exchanges that lacks transparency, making it easier for extremist groups like ISIS and al Qaeda to divert funds undetected. The difficulty of transferring money is also preventing aid groups from paying local staff and suppliers, which has “delayed or prevented the delivery of development assistance in both government and besieged areas,” according to the report.

Trade restrictions on Syria are even more convoluted. Items that contain 10 percent or more of U.S. content, including medical devices, are banned from export to Syria. Aid groups wishing to bypass this rule have to apply for a special license, but the licensing bureaucracy is a nightmare to navigate, often requiring expensive lawyers that cost far more than the items being exported.

Syria was first subjected to sanctions in 1979, after the U.S. designated the Syrian government as a state sponsor of terrorism. More sanctions were added in subsequent years, though none more extreme than the restrictions imposed in 2011 in response to the Syrian government’s deadly crackdown on protesters.

In 2013 the sanctions were eased but only in opposition areas. Around the same time, the CIA began directly shipping weapons to armed insurgents at a colossal cost of nearly $1 billion a year, effectively adding fuel to the conflict while U.S. sanctions obstructed emergency assistance to civilians caught in the crossfire.

TO GO WITH AFP STORY BY SAMMY KETZA banker stacks packed Syrian lira bills at the Central Bank in Damascus on August 25, 2011. US sanctions have forced Syria to stop all transactions in US dollars, with the country turning completely to euro deals, the governor of the Central Bank Adib Mayaleh told the AFP during an interview. AFP PHOTO/JOSEPH EID (Photo credit should read JOSEPH EID/AFP/Getty Images)

A man stacks packed Syrian lira bills at the Central Bank in Damascus on Aug. 25, 2011.

Photo: Joseph Eid/AFP/Getty Images

An internal U.N. email obtained by The Intercept also faults U.S. and EU sanctions for contributing to food shortages and deteriorations in health care. The August email from a key U.N. official warned that sanctions had contributed to a doubling in fuel prices in 18 months and a 40 percent drop in wheat production since 2010, causing the price of wheat flour to soar by 300 percent and rice by 650 percent. The email went on to cite sanctions as a “principal factor” in the erosion of Syria’s health care system. Medicine-producing factories that haven’t been completely destroyed by the fighting have been forced to close because of sanctions-related restrictions on raw materials and foreign currency, the email said.As one NGO worker in Damascus told The Intercept, there are cars, buses, water systems, and power stations that are in serious need of repair all across the country, but it takes months to procure spare parts and there’s no time to wait. So aid groups opt for cheap Chinese options or big suppliers that have the proper licensing, but the big suppliers can charge as much as they want. If the price is unaffordable, systems break down and more and more people die from dirty water, preventable diseases, and a reduced quality of life.

Such conditions would be devastating for any country. In war-torn Syria, where an estimated 13 million people are dependent on humanitarian assistance, the sanctions are compounding the chaos.

In an emailed statement to The Intercept, the State Department denied that the sanctions are hurting civilians.

“U.S. sanctions against [Syrian President Bashar al-Assad], his backers, and the regime deprive these actors of resources that could be used to further the bloody campaign Assad continues to wage against his own people,” said the statement, which recycled talking points that justified sanctions against Iraq in 1990s. The U.S. continued to rationalize the Iraq sanctions even after a report was released by UNICEF in 1999 that showed a doubling in mortality rates for children under the age of 5 after sanctions were imposed in the wake of the Gulf War, and the death of 500,000 children.

“The true responsibility for the dire humanitarian situation lies squarely with Assad, who has repeatedly denied access and attacked aid workers,” the U.S. statement on Syria continued. “He has the ability to relieve this suffering at any time, should he meet his commitment to provide full, sustained access for delivery of humanitarian assistance in areas that the U.N. has determined need it.”

Meanwhile, in cities controlled by ISIS, the U.S. has employed some of the same tactics it condemns. For example, U.S.-backed ground forces laid siege to Manbij, a city in northern Syria not far from Aleppo that is home to tens of thousands of civilians. U.S. airstrikes pounded the city over the summer, killing up to 125 civilians in a single attack. The U.S. also used airstrikes to drive ISIS out of KobaneRamadi, and Fallujah, leaving behind flattened neighborhoods. In Fallujah, residents resorted to eating soup made from grass and 140 people reportedly died from lack of food and medicine during the siege.

A Syrian man walks past an empty vegetable market in Aleppo on July 10, 2016, after the regime closed the only remaining supply route into the city.

A Syrian man walks past an empty vegetable market in Aleppo on July 10, 2016, after the regime closed the only remaining supply route into the city.

Photo: Karam Al-Masri/AFP/Getty Images

Humanitarian concerns aside, the sanctions are not achieving their objectives. Five years of devastating civil war and strict economic sanctions have plunged over 80 percent of Syrians into poverty, up from 28 percent in 2010. Ferdinand Arslanian, a scholar at the Center for Syrian Studies at the University of St. Andrews, says that reduction in living standards and aid dependency is empowering the regime.“Aid is now an essential part of the Syrian economy and sanctions give regime cronies in Syria the ability to monopolize access to goods. It makes everyone reliant on the government. This was the case in Iraq, with the food-for-oil system,” explained Arslanian.

“Sanctions have a terrible effect on the people more than the regime and Washington knows this from Iraq,” argues Joshua Landis, director of the Center for Middle East Studies at the University of Oklahoma. “But there’s pressure in Washington to do something and sanctions look like you’re doing something,” he added.

Despite the failure of sanctions, opposition advocates are agitating for even harsher measures that would extend sanctions to anyone who does business with the Syrian government. This, of course, would translate into sanctions against Russia.

“The opposition likes sanctions,” says Landis. “They were the people who advocated them in the beginning because they want to put any pressure they can on the regime. But it’s very clear that the regime is not going to fall, that the sanctions are not working. They’re only immiserating a population that’s already suffered terrible declines in their per capita GDP,” he added.

Read the report:

Hum Impact of Syria Related Res Eco Measures 26 May 2016, 40 pages

Top photo: A Syrian Red Crescent truck, part of a convoy carrying humanitarian aid, is seen in Kafr Batna on the outskirts of Damascus on Feb. 23, 2016, during an operation in cooperation with the U.N. to deliver aid to thousands of besieged Syrians.

Update: September 30, 2016

The wording of a paragraph about U.S. tactics in Syria and Iraq has been altered to clarify that the U.S. used a strategy of airstrikes against Kobane, Ramadi, and Fallujah when they were controlled by ISIS forces

The “New Turkey”: Fetishizing Growth with Fatal Results

The “New Turkey”: Fetishizing Growth with Fatal Results

by Zuhal Yeşilyurt Gündüz

Zuhal Yeşilyurt Gündüz is an associate professor in Political Science and International Relations at TED University in Ankara, Turkey.

“This is not something that suddenly happened. I can tell you that there are people here who are dying, people who are injured and it’s all because of money…. They send us here like lambs to slaughter. We are not safe doing this job.” —Özcan Cüce, Soma mine disaster survivor1

Turkey’s ruling party has turned the country, which it calls “the new Turkey,” into a capitalist nightmare: a triad of neoliberal economics, political despotism, and Islamist conservatism. This article provides an overview of neoliberalism in Turkey, then looks at the government’s extraction policies, highlighting the Soma mine massacre as one tragic example of the destructive policies of the governing party, the Adalet ve Kalkınma Partisi (AKP, Justice and Development Party). It also examines the extreme authoritarianism of President Recep Tayyip Erdoğan (formerly prime minister), and the growing cultural-relgious conservatism, which the AKP has interlaced with Islamist rhetoric. This hegemonic triad of neoliberalism, despotism, and conservatism is an especially dangerous one. However, it is being increasingly criticized, and resistance movements against neoliberal policies are growing. All of this gives some hope for Turkey’s future.

Neoliberalism in Turkey

Turkey used to be an agriculture powerhouse—one of only seven countries that could feed its people without agricultural imports. Turkey used to have state-led industrialization, import substitution, and protectionism, and still registered economic and industrial growth (although it also faced unemployment, high inflation, and debt problems). Turkey used to be all this and much more. After all, Turkey is a beautiful country, surrounded on three sides with seas. It has great lakes and rivers, huge forests, high mountains, and grand water falls.

However, much of this was crushed beginning January 24, 1980, the day neoliberalism entered Turkey and the government instituted a set of drastic economic restructuring measures. The ruling center-right Adalet Partisi (Justice Party) began a neoliberal program, which built upon capital accumulation and export support, opened the Turkish economy to foreign capital penetration, and turned the state into a mere servant of capital accumulation. Export subventions, privatization, deregulation, and finance and trade liberalization continuously increased.2 Eight months later, the military intervened and ran the country for three years, during which it did its best to demolish the left and strengthen the neoliberal regime. Nothing was as it used to be and the changes realized in Turkey fulfilled the wishes and dreams of the Western powers, whether dressed as the IMF, World Bank, United States, or European Union. The neoliberal system was further developed under Turgut Özal, who was first prime minister (1983–1989) and then president (1989–1993). The many economic crises (1994, 1999, 2001, and 2008–2009) did not bring a reversal of neoliberalism; instead, it was further fostered by the very crises it had created.3

Turkey’s neoliberalism culminated in the new millennium with the rise of the AKP, a party with an Islamist background. The party wedded Islamist populism to neoliberalism, which has been critically dubbed “neoliberalism with a Muslim face.”4 By winning over liberal intellectual and economic circles, the AKP has built a historic bloc with Islamic sentiments; İlhan Uzgel calls it “the new hegemonic bloc.”5 Thus, in order to alter Turkey, the AKP initially had to alter itself.6

Under the AKP, the state became a facilitator of a neoliberal market economy and the protector of private capital. It no longer had a role in production, and totally integrated the Turkish economy with global markets. The party also continued the IMF program in full accord with business circles.7 In order to attract the popular classes (and their votes), the AKP connected traditional religious values with liberal ones such as globalization. Though Islam was not constructed as the core reference point, its role is vital to the AKP’s cultural-religious conservatism, and thus the party embodies not only the intersection of Islam and democracy, but also Islam and neoliberalism.8

What the AKP claimed as an “economic miracle” was nothing of the sort. Austerity policies, finance-driven growth, a private capital growth imperative, privatization, commodification of public services, huge rent regions from privatized lands that were formerly commons, decreasing security and living standards, wage cuts, cheap and easy-to-hire-and-fire labor, finance capital inflows, and a high trade deficit—this is not an “economic miracle.” Real production is diminishing and Turkey depends more and more on importing intermediary and capital goods, energy of all kinds, and even agricultural products.9

The AKP’s economic model is built on two pillars. The first is crazed consumption via consumer credit. Turkey, with 74 million people, has 57 million credit cards with a total debt of $45 billion. Giving the public consumer credit en masse was the main factor in Turkey’s growth and “the magic trick that filled empty malls, and the opium that kept the majority of people quiet, happy and obedient.”10 The second pillar is immense rent gains via commercialization of the commons. Lands, rivers, mountains, farmland, historical buildings, forests, parks—nothing is safe from commodification.11

The result of the AKP’s policies was a continuous pauperization of the population and an increase in income injustice. In order to decrease social tensions and conflict, the AKP turned to “charity”—which it painted in Islamist colors. Thus, while weakening social policies and therefore public responsibility, the AKP promoted philanthropy to soften and ease the plight of the poor. By forgoing social welfare practices, the AKP maintained a “mercy economy,” for the very poor.12

Turkey may show signs of aggregate GDP growth. It may now be formally the sixteenth-largest economy, arrogantly pronouncing huge jumps towards “the new Turkey,” and striving towards the Top Ten. But in various global indexes, the country has fared much worse: in the UNDP’s Human Development Index 2013, Turkey was ninetieth; in Transparency International’s 2014 list, sixty-fourth; in the 2014 Gender Gap Index of the World Economic Forum, it was one-hundred twenty fifth; and in the Climate Change Performance Index 2014, Turkey was among those countries considered “very bad.”13

Growth Fetishism with Fatal Results

It is more than a tragic irony that the AKP dubbed 2014 the “year of the environment,” while it more honestly should have called it the year (or decade) of extreme exploitation of the environment!

The AKP’s neoliberalism comes with tragic outcomes. This “merciless growth,” which easily relinquishes humans, environment, and the commons for the “absolute fetish of economic growth,” is driven by the construction sector, whose dynasts have passionate relations with the government.14 People are not given a chance to participate in decision-making, even on issues that concern their lives deeply. Cities are opened up endlessly to the services of capital. It is no surprise, then, that Istanbul is now called “the city, which sold its soul to capital.” Cities resemble huge construction areas and some areas are so full of skyscrapers, apartment blocks, and other huge buildings that it just takes one’s breath away—in the most negative sense of the term. The AKP’s development endeavors—the skyscrapers and business towers—steal even the ability and right to see the sky above.15

The AKP managed to connect consumption and construction closely with each other. Whereas a decade ago there were a few shopping malls in Turkey, by May 2014 the number has reached 329, with Istanbul alone being home to ninety-seven malls. In comparison, London has forty-two, Berlin and Rome have forty-three, Barcelona has forty-five, and Paris “just” fifteen. In the first seventy-nine years of the Republic of Turkey, twenty-six airports were built, and during the twelve years of AKP rule, twenty-six new ones have been added—with more to come.16 Huge skyscrapers, shopping malls, the third bridge over the Bosporus, the third airport in Istanbul, nuclear plants aside hydroelectric and thermal power plants, and many more projects constitute Turkey’s “development.” More income for corporations means the opposite for all others, as people pay the price for this type of “growth.” Some lose their health and others their lives, in addition to environmental destruction such as the loss of forests, land, and clean drinking water. Claudia von Werlhof describes this bluntly: “While a tiny minority reaps enormous benefits from today’s economic liberalism, the vast majority of the earth’s human and non-human population, and the earth itself, suffer hardship to an extent that puts their very survival at risk.”17

The AKP’s program is built upon economic growth and ever-growing capital, and for this reason the government resists increasing workers’ safety regulations. According to the Workers Health and Safety Group, between 2002 and 2014 at least 14,455 workers have lost their lives at work. The report reveals a continuous increase: 811 workers died in 2003, 1,235 in 2013, and 1,600 in the first ten months alone of 2014.18 Turkey ranks first in Europe (eight-and-a-half times higher than the EU average) and third globally in workplace accidents. From 2002 to 2011, workplace accidents have risen by 40 percent—a daily average of 219 accidents, with four deaths and five left unable to work. The mine sector is the most dangerous, with over 10 percent of miners suffering accidents at work. These are the deadly outcomes of three decades of privatization, subcontracting, outsourcing, poor occupational safety and health regulations, and insufficient, pre-arranged, pro-corporate inspections by authorities.19 These factors make Turkey “cheap” and “competitive” globally—perfect to serve Western capitalism.


In order to grow and develop, or so the AKP-written story goes, Turkey needs energy. As the country depends on energy imports while simultaneously “sitting” upon various forms of natural resources, the AKP stimulates the buildup of a “less energy dependent Turkey.” The fairy tales about the “need” for “more energy,” more coal mines and coal extraction, more hydroelectric and thermal power plants—plus the “must” for nuclear energy plants—is repeated over and over again by President Erdoğan and the AKP, who dream of a fossil-fuel dependent energy policy. They ask, “How else could Turkey grow? How else could it get rich?”

Turkey’s energy dependency is indeed quite impressive: it imports 98.6 percent of gas, 93 percent of oil, and 92 percent of coal. In 2012, 75 percent of all energy consumption was imported, while the rest was supplied from lignite (brown coal) production.20 Therefore, the story goes, Turkey should use its “own” resources and extract more of these natural resources from domestic sources.

In “The New Extractivism,” Henry Veltmeyer and James Petras deal with this issue, defining extractivism as a decision by governments and corporations to extract more and more natural resources and to export these primary goods in order to “develop” economically and “cure” global recession, while disregarding the health, social, and environmental costs of this policy. Extractivism as a model of accumulation has a history going back five hundred years. When the capitalist system began to colonize huge parts of the globe, it structured itself around the raw materials found there. Since then, extractivist accumulation has been decided upon as a general policy (indeed a necessity of their existence by the natural-resource hungry centers of capitalism). Alberto Acosta reminds us of “the paradox of plenty” and “the resource curse”—and that it is always transnational corporations that are the “major beneficiaries of these activities.”21 Extractivism goes beyond resource extraction and implies a development model. Fossil energy is not only the basis for capitalist production, but also the major force of capitalism and capitalist growth.22 This indeed is “today’s imperialist plundering.”23

It is here that the AKP joined this neoliberal game, and 2012 was a turning point. Decreasing growth rates, lessening of foreign capital income, and the effect of the global economic crisis were all felt in Turkey. The AKP came up with the idea to decrease Turkey’s energy dependency and to turn to a domestic energy production, built upon domestic coal. The government would privatize land with coal areas, while giving incentives and guarantees to buy the produced goods. Capital meanwhile would build up thermal power plants, diminish workers’ safety and work guarantees, decrease costs of production, and sell their goods, as promised. And the remaining coal would be given away as charity coal bags for the AKP, especially before elections. Agricultural farming land would be part of emergency expropriation. Thus, the AKP loudly claimed it would turn the “crisis into an opportunity”—whereas in reality they created a neoliberal plunder economy.24

Between 2003 and 2011, 66 percent of Turkey’s growth was based on twelve sectors. Half of them were connected to construction and construction-related fossil-fuel sectors, which are all dependent on foreign imports or investments. Imported gas and coal accounts for 55.8 percent of the electricity produced in thermal power plants, and nearly all coal and steel is imported. Thus, Turkey’s growth in these sectors also means a growth in its trade deficit.25

Prime Minister Ahmet Davutoğlu’s November 6, 2014, announcement of Turkey’s tenth development plan for the years 2014–2018 highlights energy as a main priority. Davutoğlu stated that legislation would be finalized soon to boost local construction of hydropower turbines exceeding 50 megawatts, to stimulate coal-fired thermal power plants all over Turkey’s lignite areas by the end of 2015 through public-private cooperation, and to minimize the scrap dependence for raw materials by the iron-steel sector. This will bring an extractivism explosion to Turkey. However, as most of the coal-fired thermal power plants are driven with imported coal, it will by no means bring a lessening of dependency. Given the government’s drive to become a “global energy hub” and a vital geopolitical power “Turkey’s obsession with a fossil-fuel-driven developmentalism” is hardly surprising.26

The development plan highlights an energy production program that leans on local resources and a program to improve energy efficiency, and seeks to increase the amount of national resources in energy production from 27 to 35 percent. As there are no oil and gas reserves in Turkey, what is meant by “national or local resources” is lignite, which has the worst efficiency and highest waste among coal types. And what is meant by “improving efficiency” is to build thermal power stations on lignite areas all over the country. It is obvious that this plan does not take into consideration the well-being of humans or nature. Its main priority is capital maximization, plundering, and marauding—as much and as long as it can.27

However, reports reveal that the government’s projections of energy needs are at least 25 percent higher than they are in reality. Turkey has the potential to have 47 percent of energy consumption come from renewable energy by 2030, at economic costs that are no higher than the current energy policy, and at human and social costs that are much lower than the current ones.28 Turkey has one of the best renewable energy potentials in Europe, with 380 billion kilowatt-hours of energy that could come from solar photovoltaic energy and 48,000 megawatts wind capacity (Turkey’s current capacity is only 2,000 megawatts). Renewable energy resources are clean, safe, and create employment. The European Wind Energy Association stresses that building a 1 megawatt wind turbine creates fifteen new jobs.29 But instead of turning to clean energy, the AKP keeps on insisting on dirty energy policies by repeating the lie that “our country needs energy.”

Besides, what are considered “energy needs” does not include energy used by households. Data reveals that the increase in energy consumption from 2009 to 2010 was close to 15,150,000 megawatt hours. While 15 percent of the increase stemmed from households, the rest was from industry and trade. Similar results can be seen in the increase from 2010 to 2011.30 Thus, not only are the energy increase estimates overestimates, but the AKP refuses to mention the real reason for the increase: industrial production geared to capital accumulation.

Another predicament is the AKP’s “heroism literature” on nuclear energy. Number one on this list is, “If Turkey does not build nuclear plants, it will remain without electricity.” By repeating this lie over and over, the AKP tries to justify its dangerous decision to build nuclear plants. The story goes, “Turkey faces a quick increase in energy and electricity demand and we have to do something.” Experts stress that the Ministry of Energy and Natural Resources’ projections do not reflect reality. Özgür Gürbüz points to a failure to confront the issue of inflated electricity demand, saynig the government is “shockingly slow off the mark” in taking measures to decrease losses in energy efficiency associated with the transmission and distribution of electrictity.31 Thus the aim is to build two nuclear power plants, one in Akkuyu on the Mediterranean coast (in an earthquake-prone region) and one in Sinop on the Black Sea; both are beautiful places that will be ruined. Regulations about critical issues like security and nuclear waste were not dealt with at all. The government’s disinformation and political repression leaves no hope for court cases against the nuclear plants.


The Soma district in the Aegean province of Manisa used to be beautiful farm land, rich with crops like tobacco, olives, wine grapes, and wheat.32 It was a prosperous agricultural region until the 1990s, when the state stopped giving agricultural subsidies. Farming became a difficult way to make a living, and many people left for the big cities. Soma was turned into a huge coal-mining district, resulting in deforestation, decreasing fertility of farming land, and the pollution of soil, air, and water. Many of those who stayed in Soma—which is home to nearly 40 percent of Turkey’s two billion ton lignite coal reserve, as well as a lignite-fired thermal power plant—found work in one of the (then state-owned) coal mines. Today, out of a population of 105,000, the mining industry employs 16,000. On the entrance wall of Soma’s state hospital you can read the fatalistic sentence, “For those who give a life for a handful of coal.”

Truly, Turkey has become a country that removes both natural resources and corpses from underneath the earth. Enslaved workers await death while laboring under inhumane conditions for their families’ sheer survival. The AKP’s neoliberal policies minimize agriculture and turn land workers into mine workers; instead of farming above the soil, they are forced to dig underneath the earth.

The tragic mine disaster in Soma on May 13, 2014, was only one of many deadly incidents. What was different was the sheer number of workers killed—301 mine workers in one so-called “accident.” calls it “one of the greatest workplace murders in Turkish history.”33 CEO of Soma Holding Alp Gürkan previously had proclaimed that they had succeeded in reducing production costs from $130 to $24 a ton after privatization in 2005. This “success” was, unsurprisingly, the result of cuts in production costs like wages and safety measures. Most mine workers are insufficiently trained, and are temporary or unregistered workers; some are even underage. Despite this, in July 2013 the Minister of Energy and Natural Resources applauded Soma Holding for creating “exemplary mining complexes that prioritize the safety of miners.” Wages are so dismal that, for shifts as long as twelve hours, the salary a mine worker receives is as low as 420 euros—just above the official hunger line (the amount of money necessary for buying enough food for a family—as opposed to the more common “poverty line,” which includes costs like rent, transportation, and education) for a four-person household of 402 euros. Soma Holding then invested the Soma profits in Istanbul’s high-profit construction sector. Yaşar Adanalı, a researcher of urban development, says:

The capital accumulated by the exploitative working conditions is highly visible in the city [Istanbul], as it fuels the erection of many speculative real estate projects, such as the Spine Tower of Soma Corporation. The Spine Tower in Maslak, the major business district in Istanbul, is the tallest skyscraper in town and one of the most expensive, with its $10,000 price tag per square metre…. After the Soma Massacre, people in Istanbul had organised various protests in front of the Spine Tower Project, stating that “the blood of the workers is dripping from the tower.”34

Remarkably, in October 2013, seven months before the massacre, Özgür Özel, a parliamentarian from the main opposition party Cumhuriyet Halk Partisi (CHP, the Republican People’s Party), had proposed a parliamentary commission to investigate the very high number of workplace accidents and deplorable security measures of the Soma mines, and to improve safety regulations. This was rejected by the AKP on April 29, 2014, with an AKP parliamentarian declaring Turkish mines to be safer than those of most countries! And what else could he say? Soma Holding and the government had such close ties that the wife of the company’s general director was an AKP councilor.

Intimidation is one way the AKP fills large meeting areas all over Turkey. For example, Soma Holding workers were forced to participate in an AKP meeting before the local elections in March 2014. They were told that if they refused to go, they would not be paid that day.35 Some weeks after the disaster, a parliamentary inquiry commission for Soma was finally established with all parties’ consent. This, however, was too little, too late for the victims of the massacre.

Another aspect of the AKP’s conservative Islamist policies is impoverishing and victimizing the people, and then giving them Islamic alms instead of rights-based social welfare. Indeed, it was Soma’s bloodstained coal that was provided as charity coal bags for the earlier local elections—consolation prizes for workers whose benefits had been stolen and jobs destroyed by the same party.

Another Erdoğan method is to dismiss criticism by normalizing workplace accidents. In an “accident” that resulted in thirty dead coal miners in May 2010 in northern Turkey’s Karadon, he used Islamist fatalism to shrug off criticism by stating “death is in the nature of mining” and it is part of the “profession’s fate.” After Soma, Erdoğan referred to the many who died in European and U.S. mine disasters in the nineteenth and early twentieth centuries to minimize the tragedy. He and his bodyguards also attacked the mourning families directly. National trade union protests after the disaster were ferociously met by police with water cannons and tear gas, and military troops were sent to the region to repress protests by the grieving families.36

Iron despotism is widening all over Turkey. Aslı Iğsız says that the law is “deployed to concentrate power and to promote neoliberal institutionalization, whereas those who are unhappy with these policies are criminalized. This was exemplified in the Gezi protests.”37 During the summer 2013 Gezi resistance increased against privatization of the commons, the destruction of the environment, growing conservatism, and increasing despotic rule. Erdoğan violently suppressed the protests. Police used 130,000 tons of tear gas canisters and water cannons—some of which launched water mixed with chemicals—on the protestors. Well over 2.5 million people, in all but two Turkish cities, participated in the Gezi resistance. Eight young men (including a fourteen-year old) were killed, nearly 5,000 people were taken into custody, and over 4,000 were injured.38 The government’s answer to peaceful protests was as repressive as possible.


On October 28, 2014, just six months after the massacre in Soma, in an Ermenek/Karaman coal mine eighteen miners were trapped 300 meters underground by 11,000 tons of water pressing on a broken wall. The miners were on a lunch break, which they were forced to take underground since the mine owner would not allow them to eat above the earth, as this would take too long—lessening profits. Later it became public that mine workers had sent 124 complaint letters to the Labor Ministry about the mine’s inhuman and unsafe conditions.39

A month later, there was the olive tree murder in Yırca, very close to Soma. The murderer was Kolin Holding, one of the clientelist construction and energy corporations, helping to build Istanbul’s third airport, which will destroy the Kuzey Forests there. Kolin felled 6,000 olive trees overnight—most of them with their fresh olives on their twigs—to build a coal-fired thermal power plant. Public-private cooperation worked perfectly here, and the emergency expropriation of May 10, 2014, occurred without notifying the peasants, whose very survival depends on the olive trees and their lands. Whereas the law states that emergency expropriation can be applied under very exceptional circumstances (such as a war or state of emergency), the AKP prefers this method when seizing peasants’ land to give to comprador companies.40 The next morning the State Council’s decision was made public: Kolin was not given permission to build a thermal power plant at Yırca. Thus, the people of Yırca experienced the most depressing and exhilarating feelings within the span of a few hours. And at the moment of the announcement about the power plant, they picked up their tools and did what they are best at—planting new olive trees.

Soma, Ermenek, and Yırca—these are just a few examples of a much larger story. For many years the Bergama district, close to the city of Izmir, has fought against gold mining and the use of sulfuric acid for extracting gold. In the Çaldağı district of the city of Manisa, the fight against the poisoning of the soil with sulfuric acid to extract nickel has been going on for years, with CHP deputy Hasan Ören helping lead the fight. Two hundred thousand trees have been felled by the company that aims at extracting nickel. Activists protest the mine because it will poison the valuable area close to Gediz Valley, which is vital for agricultural farming. If they fail, two million trees may be felled at this beautiful mountain and Gediz Valley will no longer be home for agriculture.

In September 2014, ten workers were killed when an elevator rocketed to the ground from the thirty-second floor of an under-construction luxury skyscraper in Mecidiyeköy in the Şişli district of Istanbul as safety regulations were disdained. Disregarding a court rule to stop the construction of a mosque in the Validebağ Grove in Istanbul, construction vehicles came in and could not be stopped by those who resisted. Erdoğan declared the protestors as “enemies” of mosques. In Alakır Valley, a natural preservation site, five hydroelectric power plant projects are being built, with hundreds more to come. These are just some examples of what what is happening on a monthly basis in Turkey.

Every single little park, small sea, and tiny forest faces the same fate: someone will come and find a way to make money by destroying it. This growth-at-any-cost policy is obviously not sustainable. What strikes a human being most is the “normalization” of these accidents, injuries, and deaths. What happens in Turkey during a single day should be more than enough for a year, or two, or longer! This leaves us breathless, hopeless, and devastated. However, it is this neoliberal style of privatization, deregulation, and wage declines—so dangerous for humans—that makes Turkey lucrative and attractive for Western capital. This is the reason why the neoliberal Western countries are no less guilty than the AKP itself for keeping this system alive—and enriching themselves, too.


The “new Turkey” is built upon a triad of marauder capitalism, repressive government, and conservative Islamism.41 Any analysis of Turkey needs to understand this first. This also means that resistance is insufficient as long as it does not also include resistance against political repression and Islamist conservatism, as they all feed on each other.

The Gezi resistance against disaster capitalism’s urban and energy projects—which destroy the environment and the commons—and against growing state repression and conservatism was a turning point in Turkey. The Soma protests from May to June 2014 added to awareness of the unscrupulousness of the regime of capital. Michael Hardt says: “This is a turning point in the public recognition of the destruction of Erdoğan’s neo-liberal policies that create wealth for a few and undermine the well-being of the many including the working class.”42 He added, “It is certainly an opportunity but one that must confront numerous hurdles, including not only a powerful government repression and propaganda machine but also the relative lack of existing political and cultural ties among different sectors of the contemporary working class.”43

Currently resistance to the AKP’s policies are going on all over Turkey. One example of months of resistance is Fatsa, on the Black Sea, where people are fighting the use of cyanide in gold mining, which will destroy the forests and farmland. Their slogan is easy to grasp: “What is above the earth is worth much more than what is underneath!” In Turkish, this is play on words: Toprağın üstü altından değerlidir! also means “What is above the earth is worth much more than gold!” This slogan has become a common one in struggles against AKP energy policies. Studies of the Kaz and Çaldağı Mountains reveal that with a more sustainable agriculture and a focus on animal husbandry, a much higher income could be earned, the peasants could keep on producing food, the environment would be saved, and less energy would be needed. Instead the insistence on extracting resources will only destroy the environment and agricultural production, as well as the lives and health of the people. So it is best to keep under the earth what is underground. Indeed, mother earth knows best—otherwise she would have put those assets above ground herself!

The social philosophy that increasingly inspires South America—sumac kawsaym, buen vivir [good living]—is worth considering globally. It is a community-centric, ecologically balanced, and culturally sensitive way of living that is built upon harmony between humans and harmony between humans and nature. Eduardo Gudynas, a leading scholar, stresses the need to consume less, understand the beauty of the small and little, and change production processes.44 But this necessarily entails both resistance and ecological revolution. Ignacio Sabbatella states “even with good intentions, the transition towards an ecological society is no more than a utopia if the foundations of capitalist production and reproduction are not questioned and altered.”45 This then brings us to Joel Kovel’s eco-socialism, aiming at renovating the “integrity of our relationship to nature…. Eco-socialism is the ushering in, then, of a whole mode of production, one in which freely associated labor produces flourishing ecosystems rather than commodities.”46

In spring 2011, peasants from all over Turkey, together with their animals, walked for weeks to Ankara to protest against hydroelectric power plants that harmed the rivers and waterways on which their farms depended. For generations they had worked in flourishing ecosystems and did not harm the earth. Now they came to a point of no return as they lost more and more of their valuable lands and waters to dirty energy policies. After weeks of walking they were not even allowed to enter the Turkish parliament to express their predicament. Their slogan Anadolu’yu vermeyeceğiz (“We will not give away Anatolia”—Anatolia is the greater, Asian part of Turkey) was widely heard, although not by the AKP, but by others. Anadolu (Anatolia) spirit, just like the Gezi spirit, is still felt all over Turkey. It is vital to widen these protests and to make them all-encompassing. This is the only way for us all to survive—buen vivir!


1 Turkey Coalmine Collapse in Manisa Kills at least 205 and Traps Hundreds Underground,” updated May 14, 2014,

2 Nilgün Onder, “The Turkish Political Economy: Globalization and Regionalism,” Perspectives on Global Development and Technology 6 (2007): 231–33.

3 Pınar Bedirhanoğlu, Restrukturierung des türkischen Staates im Kontext der neoliberalen Globalisierung (Münster: Westfälisches Dampfboot, 2008), 111.

4 Simten Coşar and Aylin Özman, “Centre-right Politics in Turkey after the November 2002 General Elections: Neoliberalism with a Muslim Face,” Contemporary Politics 10, no. 1 (2004): 57–74. See also Simten Coşar and Gamze Yücesan-Özdemir, eds., Silent Violence: Neoliberalism, Islamist Politics and the AKP Years in Turkey (Ottawa: Red Quill, 2012).

5 İlhan Uzgel, “AKP: Neoliberal dönüşümün yeni aktörü,” in İlhan Uzgel and Bülent Duru, eds., AKP kitabı: Bir dönüşümün bilançosu (Ankara: Phoenix, 2009), 12, 25.

6 Ibid, 12, 27.

7 Onder, “The Turkish Political Economy,” 241.

8 Uzgel, “AKP,” 22–24.

9 T. Sabri Öncü, “The Standing Man of Turkey,” June 21–23, 2013,

10 Joris Leverink, “‘Today We Resist’: Celebrating Gezi One Year Later,” May 31, 2014,

11 Öncü, “The Standing Man of Turkey.”

12 Metin Altıok, “Neo-liberal Yapısal Uyum Sürecinde Son Evre: AKP Hükümeti,” Toplum ve Demokrasi 1, no. 1 (September–December 2007): 70–71.

13 UNDP, “Turkey Ranks 90th in Human Development Index,” March 15, 2013,; Transparency International, “Corruption by Country,” accessed April 10, 2015,; World Economic Forum, The Global Gender Gap Report 2014 (Geneva: WEF, 2014),, 10, 11, 13, 26; Climate Change Performance Index 2014, various charts,

14 Halil Gurhanli, “Mass Murder in Soma Mine: Crony Capitalism and Fetish of Growth in Turkey,” June 9, 2014,

15 AKP’nin neoliberal çılgınlıkları: Rant, yoksulluk, beton,” November 22, 2014,

16 AVM sayısı 329’a ulaştı, 24 il AVM’siz kaldı,” May 25, 2014,; “Erdoğan: Hani Mustafa Kemal demir ağlara çok düşkündü,” Sol Gazete, June 19, 2014,

17 Claudia von Werlhof, “The Globalization of Neoliberalism, Its Consequences, and Some of its Basic Alternatives,” Capitalism Nature Socialism 19, no. 3 (September 2008): 94.

18 AKP’li 12 yılda 14 binden fazla işçi yaşamını yitirdi,” Cumhuriyet, November 3, 2014,

19 Kivanç Eliaçık and Burcu Türkay, “Equal Times: ‘Profits Over People=Murder in the Mines’,” May 18, 2014,

20 Mehveş Evin, “Enerjide hesaplar yanlış, gidiş felaket,” Milliyet, November 24, 2014,

21 Alberto Acosta, “Extractivism and Neoextractivism: Two Sides of the Same Curse,” in Miriam Lang, Lyda Fernando, and Nick Buxton, eds., Beyond Development (Amsterdam: Transnational Institute, 2013), 61, 67,

22 Ulrich Brand, “Energy Policy and Resource Extractivism: Resistances and Alternatives,” in Energy Policy and Resource Extractivism: Resistances and Alternatives; Reader of the Seminar in Tunis, 24–26 March 2013, compiled by Marlis Gensler (Brussels: Rosa Luxemburg Stiftung, 2013),, 3.

23 Cristóbal Kay, book blurb for Henry Veltmeyer and James Petras, The New Extractivism,

24 Deniz Yıldırım, “Soma, Yatağan, Ermenek: Bütünlüklü saldırı,” Birgün, November 2, 2014,

25 Melis Alphan, “Büyüyoruz da, nasıl büyüyoruz ona bakalım,” Hürriyet, June 9, 2014,

26 Ethemcan Turhan, “Soma, Ermenek, Yirca: Can Anti-Coal Activists Defend Coal Miners and Olive Farmers?,” December 18, 2014,

27 2015’i örgütlemeye…–Aktüel Gündem,” December 31, 2014,

28 Güncelleme Tarihi, “Kömüre Hücum’un Ekonomik Bir Alternatifi Var,” November 17, 2014,

29 Özgür Gürbüz, “Which Is More Dangerous: Nuclear Lies or Radiation?,”, 36.

30 “AKP’nin neoliberal çılgınlıkları.”

31 Gürbüz, “Which Is More Dangerous: Nuclear Lies or Radiation?,” 33.

32 Arife Karadag, “Changing Environment and Urban Identity Following Open-cast Mining and Thermic Power Plant in Turkey: Case of Soma,” Environmental Monitoring and Assessment 184, no. 3 (March 2012): 1617–32.

33 Turkey’s Neoliberal Death Toll: Hundreds of Miners Died in Great Soma Massacre,” May 14, 2014,

34 Gurhanli, “Mass Murder in Soma Mine.”

35 Soma’da AKP mitingi tarifesi,” Cumhuriyet, June 10, 2014,

36 Eliaçık and Türkay, “Equal Times.”

37 Aslı Iğsız, “Brand Turkey and the Gezi Protests: Authoritarianism, Law, and Neoliberalism (Part One),” July 12, 2013,

38 2.5 milyon insan 79 ilde sokağa indi,” Milliyet,, June 23, 2014; Matze Kasper, “To Survive, the Movement Will Have to Compromise,” January 11, 2014,

39 Burak Bekdil, “Turkey’s Rules for Safety,” November 8, 2014,

40 Soma Katliamının Failleri Yırca Zeytinliklerinde!,” October 28, 2014,

41 Deniz Yıldırım, “Soma’dan Mecidiyeköy’e AKP Rejimi,” Birgün, September 14, 2014,

42 Leverink, “‘Today We Resist’.”

43 Michael Hardt, “Innovation and Obstacles in Istanbul One Year After Gezi,” June 4, 2014,

44 Oliver Balch, “Buen Vivir: The Social Philosophy Inspiring Movements in South America,” Guardian, February 4, 2013,

45 Carmelo Ruiz Marrero, “The New Latin American ‘Progresismo’ and the Extractivism of the 21st Century,” Americas Program, February 17, 2011,

46 Joel Kovel, “Why Ecosocialism Today?,” New Socialist, no. 61, Summer 2007, 11.


The United States is opposed to the right to food and water

Just because you have a right to do something does not make it right.

[Excerpted from Bill Blum, “Anti-Empire Report #131”, 11 August 2014]

The city of Detroit in recent months has been shutting off the supply of water to city residents who have not paid their water bills. This action affects more than 40% of the customers of the Detroit Water and Sewage Department, bringing great inconvenience and threats to the health and sanitation of between 200 and 300 thousand residents. Protests have of course sprung up in the city, with “Water is a human right!” as a leading theme.

Who can argue with that? Well, neo-conservatives and other true believers in the capitalist system who maintain that if you receive the benefit of a product or service, you pay for it. What could be simpler? What are you, some kind of socialist?

For those of you who have difficulty believing that an American city could be so insensitive, allow me to remind you of some history.

On December 14, 1981 a resolution was proposed in the United Nations General Assembly which declared that “education, work, health care, proper nourishment, national development are human rights”. Notice the “proper nourishment”. The resolution was approved by a vote of 135-1. The United States cast the only “No” vote.

A year later, December 18, 1982, an identical resolution was proposed in the General Assembly. It was approved by a vote of 131-1. The United States cast the only “No” vote.

The following year, December 16, 1983, the resolution was again put forth, a common practice at the United Nations. This time it was approved by a vote of 132-1. There’s no need to tell you who cast the sole “No” vote.

These votes took place under the Reagan administration.

Under the Clinton administration, in 1996, a United Nations-sponsored World Food Summit affirmed the “right of everyone to have access to safe and nutritious food”. The United States took issue with this, insisting that it does not recognize a “right to food”. Washington instead championed free trade as the key to ending the poverty at the root of hunger, and expressed fears that recognition of a “right to food” could lead to lawsuits from poor nations seeking aid and special trade provisions.

The situation of course did not improve under the administration of George W. Bush. In 2002, in Rome, world leaders at another UN-sponsored World Food Summit again approved a declaration that everyone had the right to “safe and nutritious food”. The United States continued to oppose the clause, again fearing it would leave them open to future legal claims by famine-stricken countries.

I’m waiting for a UN resolution affirming the right to oxygen.

Racism is the Foundation of Israel’s Operation Protective Edge

Racism is the Foundation of Israel’s Operation Protective Edge
Jul 30 2014, by Joel Beinin

On 30 June Ayelet Shaked, chairwoman of the Knesset faction of the ultra-right wing ha-Bayit ha-Yehudi (Jewish Home) Party, a key member of the coalition government led by Prime Minister Netanyahu, posted on her Facebook page a previously unpublished article written by the late Uri Elitzur. Elitzur, a pro-settler journalist and former chief-of-staff to Netanyahu, wrote:

Behind every terrorist stand dozens of men and women, without whom he could not engage in terrorism… They are all enemy combatants, and their blood shall be on all their heads. Now, this also includes the mothers of the martyrs, who send them to hell with flowers and kisses. They must follow their sons. Nothing would be more just. They should go, as well as the physical homes in which they raised the snakes. Otherwise, more little snakes will be raised there.

Shaked’s post appeared the day the bodies of three abducted settler teens­—Naftali Fraenkel, Gilad Shaar, and Eyal Yifrach—were discovered. It has since received more than 5,200 “likes.”

For over two weeks, Netanyahu and the media whipped the country into a hysterical state, accusing Hamas of responsibility for abducting the teens without providing evidence to support the claim and promoting hopes that they would be found alive, although the government knew that the boys were likely murdered within minutes of their abduction. Their deaths provided a pretext for more violent expressions of Israeli anti-Arab racism than ever before.

The viciousness of Mordechai Kedar, lecturer in Arabic literature at Bar Ilan University, was even more creative than Shaked and Elitzur’s merely genocidal proposal. “The only thing that can deter terrorists like those who kidnapped the children and killed them,” he said, “is the knowledge that their sister or their mother will be raped.” As a university-based “expert,” Kedar’s heinous suggestion is based on his “understanding” of Arab culture. “It sounds very bad, but that’s the Middle East,” he explained, hastening to add, “I’m not talking about what we should or shouldn’t do. I’m talking about the facts.”

Racism has become a legitimate, indeed an integral, component of Israeli public culture, making assertions like these seem “normal.” The public devaluation of Arab life enables a society that sees itself as “enlightened” and “democratic” to repeatedly send its army to slaughter the largely defenseless population of the Gaza Strip—1.8 million people, mostly descendants of refugees who arrived during the 1948 Arab-Israeli war, and have been, to a greater or lesser extent, imprisoned since 1994.

Conciliatory gestures, on the other hand, are scorned. Just two days after Shaked’s Facebook post, Orthodox Jews kidnapped sixteen-year-old Muhammad Abu Khdeir from the Shu‘afat neighborhood of East Jerusalem and burned him alive in the Jerusalem Forest. Amir Peretz (Hatnua) was the only government minister to visit the grieving family. For this effort he received dozens of posts on his Facebook page threatening to kill him and his family. Meanwhile, vandals twice destroyed memorials erected to Abu Khdeir on the spot of his immolation.

The international community typically sees the manifestations of Israel’s violent racism only when they erupt as assaults on the Gaza Strip, the West Bank, or Lebanon. But Israel’s increasingly poisonous anti-Arab and anti-Muslim public culture prepares the ground of domestic public opinion long before any military operation and immunizes the army from most criticism of its “excesses.” Moreover, Israeli anti-democratic and racist sentiment is increasingly directed against Palestinian citizens of Israel, who comprise twenty percent of the population.

Foreign Minister Avigdor Lieberman of the Yisrael Beytenu (Israel Is Our Home) Party made his political reputation on the slogan “No Loyalty, No Citizenship”—a demand that Palestinian Israelis swear loyalty oaths as a condition of retaining their citizenship. Since 2004 Lieberman has also advocated “transferring” Palestinian-Israelis residing in the Triangle region to a future Palestinian state, while annexing most West Bank settlements to Israel. In November 2011 Haaretz published a partial list of ten “loyalty-citizenship” bills in various stages of legislation designed to “determine certain citizens’ rights according to their ‘loyalty’ to the state.”

While Lieberman and other MKs pursue legal channels to legally undermine the citizenship of Palestinian-Israelis, their civil rights are already in serious danger. In 2010 eighteen local rabbis warned that the Galilee town of Safed faced an “Arab takeover” and instructed Jewish residents to inform on and boycott Jews who sold or rented dwellings to Arabs. In addition to promoting segregated housing, Safed’s Chief Rabbi, Shmuel Eliyahu, tried to ban Arab students from attending Safed Academic College (about 1,300 Palestinian-Israelis are enrolled, some of whom live in Safed). The rabbinical statement incited rampages by religious Jews chanting “Death to the Arabs,” leading Haaretz columnist Gideon Levy to dub Safed “the most racist city” in Israel. In Karmiel and Upper Nazareth—towns established as part of Israel’s campaign to “Judaize the Galilee”—elected officials have led similar campaigns.

Palestinian Israeli Knesset members receive regular verbal abuse from their Jewish “colleagues.” For example, Hanin Zoabi (National Democratic Alliance), who participated in the 2010 Freedom Flotilla to the Gaza Strip, which Israeli naval commandos attacked, killing nine Turks (one of whom also held US citizenship), has been particularly targeted. In the verbal sparring over the murder of the three teens Foreign Minister Lieberman called her a “terrorist.” Not to be outdone, Miri Regev (Likud) said Zoabi should be “expelled to Gaza and stripped of her [Knesset] immunity.” Other Knesset members—some from putatively “liberal” parties—piled on. [Update: Yesterday—29 July—Hanin Zoabi was suspended from Knesset].

Violence against Arabs in and around Israeli-annexed “Greater Jerusalem” is particularly intense. Much of it is the work of Orthodox Jews. The Jewish Defense League, banned in Israel in 1994 and designated a terrorist organization by the FBI in 2001, and several similar groups regularly assault and harass Arabs. The day of the funeral of the three abducted teens, some two hundred Israelis rampaged through the streets of Jerusalem chanting “Death to Arabs.” The previous evening, hardcore fans of the Betar Jerusalem football club, known as La Familia, rallied chanting, “Death to the Arabs.”  The same chant is frequently heard at games of the team, which is associated with the Likud and does not hire Arab players. Hate marches, beatings and shootings of Arabs, and destruction of their property, long common in the West Bank, have become regular events in Israel-proper in the last month.

The citizenship-loyalty bills, Safed’s designation as “the most racist city,” the attacks volleyed at Palestinian elected officials, and mob violence against Arabs all took place before Israel launched Operation Protective Edge on 8 July. The operation—more aggressively dubbed “Firm Cliff” in Hebrew—constitutes Israel’s third assault on the Gaza Strip since 2008. As of yesterday, 29 July, the Palestinian death toll in that operation has reached over 1,200, the great majority of them civilians. Thirty-two Israeli soldiers and three civilians have also died. Israeli security officials sardonically call these operations “mowing the lawn” because well-informed observers know that Hamas cannot be uprooted and is capable of rebuilding its military capacity. There is no long-term strategy, except, as Gideon Levy put it, to kill Palestinians. Major General (res.) Oren Shachor elaborated, “If we kill their families, that will frighten them.” And what might deter Israel?

[This piece originally appeared in a special weeklong series on the Stanford University Press blog, and is reposted here in partnership with SUP blog. The entire ten-part series can be found on the SUP blog.]

Right to health: General Comment No. 14

General Comment No. 14 (2000)




The right to the highest attainable standard of health

(article 12 of the International Covenant on Economic, Social and Cultural Rights)


The right to the highest attainable standard of health :  . 11.08.2000.


E/C.12/2000/4. (General Comments)

1. Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity. The realization of the right to health may be pursued through numerous, complementary approaches, such as the formulation of health policies, or the implementation of health programmes developed by the World Health Organization (WHO), or the adoption of specific legal instruments. Moreover, the right to health includes certain components which are legally enforceable. (1)

2. The human right to health is recognized in numerous international instruments. Article 25.1 of the Universal Declaration of Human Rights affirms: “Everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services”. The International Covenant on Economic, Social and Cultural Rights provides the most comprehensive article on the right to health in international human rights law. In accordance with article 12.1 of the Covenant, States parties recognize “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”, while article 12.2 enumerates, by way of illustration, a number of “steps to be taken by the States parties … to achieve the full realization of this right”. Additionally, the right to health is recognized, inter alia, in article 5 (e) (iv) of the International Convention on the Elimination of All Forms of Racial Discrimination of 1965, in articles 11.1 (f) and 12 of the Convention on the Elimination of All Forms of Discrimination against Women of 1979 and in article 24 of the Convention on the Rights of the Child of 1989. Several regional human rights instruments also recognize the right to health, such as the European Social Charter of 1961 as revised (art. 11), the African Charter on Human and Peoples’ Rights of 1981 (art. 16) and the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights of 1988 (art. 10). Similarly, the right to health has been proclaimed by the Commission on Human Rights, (2) as well as in the Vienna Declaration and Programme of Action of 1993 and other international instruments. (3)

3. The right to health is closely related to and dependent upon the realization of other human rights, as contained in the International Bill of Rights, including the rights to food, housing, work, education, human dignity, life, non-discrimination, equality, the prohibition against torture, privacy, access to information, and the freedoms of association, assembly and movement. These and other rights and freedoms address integral components of the right to health.

4. In drafting article 12 of the Covenant, the Third Committee of the United Nations General Assembly did not adopt the definition of health contained in the preamble to the Constitution of WHO, which conceptualizes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. However, the reference in article 12.1 of the Covenant to “the highest attainable standard of physical and mental health” is not confined to the right to health care. On the contrary, the drafting history and the express wording of article 12.2 acknowledge that the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment.

5. The Committee is aware that, for millions of people throughout the world, the full enjoyment of the right to health still remains a distant goal. Moreover, in many cases, especially for those living in poverty, this goal is becoming increasingly remote. The Committee recognizes the formidable structural and other obstacles resulting from international and other factors beyond the control of States that impede the full realization of article 12 in many States parties.

6. With a view to assisting States parties’ implementation of the Covenant and the fulfilment of their reporting obligations, this General Comment focuses on the normative content of article 12 (Part I), States parties’ obligations (Part II), violations (Part III) and implementation at the national level (Part IV), while the obligations of actors other than States parties are addressed in Part V. The General Comment is based on the Committee’s experience in examining States parties’ reports over many years.


7. Article 12.1 provides a definition of the right to health, while article 12.2 enumerates illustrative, non-exhaustive examples of States parties’ obligations.

8. The right to health is not to be understood as a right to be healthy. The right to health contains both freedoms and entitlements. The freedoms include the right to control one’s health and body, including sexual and reproductive freedom, and the right to be free from interference, such as the right to be free from torture, non-consensual medical treatment and experimentation. By contrast, the entitlements include the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

9. The notion of “the highest attainable standard of health” in article 12.1 takes into account both the individual’s biological and socio-economic preconditions and a State’s available resources. There are a number of aspects which cannot be addressed solely within the relationship between States and individuals; in particular, good health cannot be ensured by a State, nor can States provide protection against every possible cause of human ill health. Thus, genetic factors, individual susceptibility to ill health and the adoption of unhealthy or risky lifestyles may play an important role with respect to an individual’s health. Consequently, the right to health must be understood as a right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health.

10. Since the adoption of the two International Covenants in 1966 the world health situation has changed dramatically and the notion of health has undergone substantial changes and has also widened in scope. More determinants of health are being taken into consideration, such as resource distribution and gender differences. A wider definition of health also takes into account such socially-related concerns as violence and armed conflict. (4) Moreover, formerly unknown diseases, such as Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS), and others that have become more widespread, such as cancer, as well as the rapid growth of the world population, have created new obstacles for the realization of the right to health which need to be taken into account when interpreting article 12.

11. The Committee interprets the right to health, as defined in article 12.1, as an inclusive right extending not only to timely and appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health. A further important aspect is the participation of the population in all health-related decision-making at the community, national and international levels.

12. The right to health in all its forms and at all levels contains the following interrelated and essential elements, the precise application of which will depend on the conditions prevailing in a particular State party:

(a) Availability. Functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the State party. The precise nature of the facilities, goods and services will vary depending on numerous factors, including the State party’s developmental level. They will include, however, the underlying determinants of health, such as safe and potable drinking water and adequate sanitation facilities, hospitals, clinics and other health-related buildings, trained medical and professional personnel receiving domestically competitive salaries, and essential drugs, as defined by the WHO Action Programme on Essential Drugs. (5)

(b) Accessibility. Health facilities, goods and services (6) have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has four overlapping dimensions:

Non-discrimination: health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds. (7)

Physical accessibility: health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations, women, children, adolescents, older persons, persons with disabilities and persons with HIV/AIDS. Accessibility also implies that medical services and underlying determinants of health, such as safe and potable water and adequate sanitation facilities, are within safe physical reach, including in rural areas. Accessibility further includes adequate access to buildings for persons with disabilities.

Economic accessibility (affordability): health facilities, goods and services must be affordable for all. Payment for health-care services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households.

Information accessibility: accessibility includes the right to seek, receive and impart information and ideas (8) concerning health issues. However, accessibility of information should not impair the right to have personal health data treated with confidentiality.

(c) Acceptability. All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.

(d) Quality. As well as being culturally acceptable, health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation.

13. The non-exhaustive catalogue of examples in article 12.2 provides guidance in defining the action to be taken by States. It gives specific generic examples of measures arising from the broad definition of the right to health contained in article 12.1, thereby illustrating the content of that right, as exemplified in the following paragraphs. (9)

Article 12.2 (a). The right to maternal, child and reproductive health

14. “The provision for the reduction of the stillbirth rate and of infant mortality and for the healthy development of the child” (art. 12.2 (a)) (10) may be understood as requiring measures to improve child and maternal health, sexual and reproductive health services, including access to family planning, pre- and post-natal care, (11) emergency obstetric services and access to information, as well as to resources necessary to act on that information. (12)

Article 12.2 (b). The right to healthy natural and workplace environments

15. “The improvement of all aspects of environmental and industrial hygiene” (art. 12.2 (b)) comprises, inter alia, preventive measures in respect of occupational accidents and diseases; the requirement to ensure an adequate supply of safe and potable water and basic sanitation; the prevention and reduction of the population’s exposure to harmful substances such as radiation and harmful chemicals or other detrimental environmental conditions that directly or indirectly impact upon human health. (13) Furthermore, industrial hygiene refers to the minimization, so far as is reasonably practicable, of the causes of health hazards inherent in the working environment. (14) Article 12.2 (b) also embraces adequate housing and safe and hygienic working conditions, an adequate supply of food and proper nutrition, and discourages the abuse of alcohol, and the use of tobacco, drugs and other harmful substances.

Article 12.2 (c). The right to prevention, treatment and control of diseases

16. “The prevention, treatment and control of epidemic, endemic, occupational and other diseases” (art. 12.2 (c)) requires the establishment of prevention and education programmes for behaviour-related health concerns such as sexually transmitted diseases, in particular HIV/AIDS, and those adversely affecting sexual and reproductive health, and the promotion of social determinants of good health, such as environmental safety, education, economic development and gender equity. The right to treatment includes the creation of a system of urgent medical care in cases of accidents, epidemics and similar health hazards, and the provision of disaster relief and humanitarian assistance in emergency situations. The control of diseases refers to States’ individual and joint efforts to, inter alia, make available relevant technologies, using and improving epidemiological surveillance and data collection on a disaggregated basis, the implementation or enhancement of immunization programmes and other strategies of infectious disease control.

Article 12.2 (d). The right to health facilities, goods and services (15)

17. “The creation of conditions which would assure to all medical service and medical attention in the event of sickness” (art. 12.2 (d)), both physical and mental, includes the provision of equal and timely access to basic preventive, curative, rehabilitative health services and health education; regular screening programmes; appropriate treatment of prevalent diseases, illnesses, injuries and disabilities, preferably at community level; the provision of essential drugs; and appropriate mental health treatment and care. A further important aspect is the improvement and furtherance of participation of the population in the provision of preventive and curative health services, such as the organization of the health sector, the insurance system and, in particular, participation in political decisions relating to the right to health taken at both the community and national levels.

Article 12. Special topics of broad application

Non-discrimination and equal treatment

18. By virtue of article 2.2 and article 3, the Covenant proscribes any discrimination in access to health care and underlying determinants of health, as well as to means and entitlements for their procurement, on the grounds of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, physical or mental disability, health status (including HIV/AIDS), sexual orientation and civil, political, social or other status, which has the intention or effect of nullifying or impairing the equal enjoyment or exercise of the right to health. The Committee stresses that many measures, such as most strategies and programmes designed to eliminate health-related discrimination, can be pursued with minimum resource implications through the adoption, modification or abrogation of legislation or the dissemination of information. The Committee recalls General Comment No. 3, paragraph 12, which states that even in times of severe resource constraints, the vulnerable members of society must be protected by the adoption of relatively low-cost targeted programmes.

19. With respect to the right to health, equality of access to health care and health services has to be emphasized. States have a special obligation to provide those who do not have sufficient means with the necessary health insurance and health-care facilities, and to prevent any discrimination on internationally prohibited grounds in the provision of health care and health services, especially with respect to the core obligations of the right to health. (16) Inappropriate health resource allocation can lead to discrimination that may not be overt. For example, investments should not disproportionately favour expensive curative health services which are often accessible only to a small, privileged fraction of the population, rather than primary and preventive health care benefiting a far larger part of the population.

Gender perspective

20. The Committee recommends that States integrate a gender perspective in their health-related policies, planning, programmes and research in order to promote better health for both women and men. A gender-based approach recognizes that biological and socio-cultural factors play a significant role in influencing the health of men and women. The disaggregation of health and socio-economic data according to sex is essential for identifying and remedying inequalities in health.

Women and the right to health

21. To eliminate discrimination against women, there is a need to develop and implement a comprehensive national strategy for promoting women’s right to health throughout their life span. Such a strategy should include interventions aimed at the prevention and treatment of diseases affecting women, as well as policies to provide access to a full range of high quality and affordable health care, including sexual and reproductive services. A major goal should be reducing women’s health risks, particularly lowering rates of maternal mortality and protecting women from domestic violence. The realization of women’s right to health requires the removal of all barriers interfering with access to health services, education and information, including in the area of sexual and reproductive health. It is also important to undertake preventive, promotive and remedial action to shield women from the impact of harmful traditional cultural practices and norms that deny them their full reproductive rights.

Children and adolescents

22. Article 12.2 (a) outlines the need to take measures to reduce infant mortality and promote the healthy development of infants and children. Subsequent international human rights instruments recognize that children and adolescents have the right to the enjoyment of the highest standard of health and access to facilities for the treatment of illness. (17)

The Convention on the Rights of the Child directs States to ensure access to essential health services for the child and his or her family, including pre- and post-natal care for mothers. The Convention links these goals with ensuring access to child-friendly information about preventive and health-promoting behaviour and support to families and communities in implementing these practices. Implementation of the principle of non-discrimination requires that girls, as well as boys, have equal access to adequate nutrition, safe environments, and physical as well as mental health services. There is a need to adopt effective and appropriate measures to abolish harmful traditional practices affecting the health of children, particularly girls, including early marriage, female genital mutilation, preferential feeding and care of male children. (18) Children with disabilities should be given the opportunity to enjoy a fulfilling and decent life and to participate within their community.

23. States parties should provide a safe and supportive environment for adolescents, that ensures the opportunity to participate in decisions affecting their health, to build life-skills, to acquire appropriate information, to receive counselling and to negotiate the health-behaviour choices they make. The realization of the right to health of adolescents is dependent on the development of youth-friendly health care, which respects confidentiality and privacy and includes appropriate sexual and reproductive health services.

24. In all policies and programmes aimed at guaranteeing the right to health of children and adolescents their best interests shall be a primary consideration.

Older persons

25. With regard to the realization of the right to health of older persons, the Committee, in accordance with paragraphs 34 and 35 of General Comment No. 6 (1995), reaffirms the importance of an integrated approach, combining elements of preventive, curative and rehabilitative health treatment. Such measures should be based on periodical check-ups for both sexes; physical as well as psychological rehabilitative measures aimed at maintaining the functionality and autonomy of older persons; and attention and care for chronically and terminally ill persons, sparing them avoidable pain and enabling them to die with dignity.

Persons with disabilities

26. The Committee reaffirms paragraph 34 of its General Comment No. 5, which addresses the issue of persons with disabilities in the context of the right to physical and mental health. Moreover, the Committee stresses the need to ensure that not only the public health sector but also private providers of health services and facilities comply with the principle of non-discrimination in relation to persons with disabilities.

Indigenous peoples

27. In the light of emerging international law and practice and the recent measures taken by States in relation to indigenous peoples, (19) the Committee deems it useful to identify elements that would help to define indigenous peoples’ right to health in order better to enable States with indigenous peoples to implement the provisions contained in article 12 of the Covenant. The Committee considers that indigenous peoples have the right to specific measures to improve their access to health services and care. These health services should be culturally appropriate, taking into account traditional preventive care, healing practices and medicines. States should provide resources for indigenous peoples to design, deliver and control such services so that they may enjoy the highest attainable standard of physical and mental health. The vital medicinal plants, animals and minerals necessary to the full enjoyment of health of indigenous peoples should also be protected. The Committee notes that, in indigenous communities, the health of the individual is often linked to the health of the society as a whole and has a collective dimension. In this respect, the Committee considers that development-related activities that lead to the displacement of indigenous peoples against their will from their traditional territories and environment, denying them their sources of nutrition and breaking their symbiotic relationship with their lands, has a deleterious effect on their health.


28. Issues of public health are sometimes used by States as grounds for limiting the exercise of other fundamental rights. The Committee wishes to emphasize that the Covenant’s limitation clause, article 4, is primarily intended to protect the rights of individuals rather than to permit the imposition of limitations by States. Consequently a State party which, for example, restricts the movement of, or incarcerates, persons with transmissible diseases such as HIV/AIDS, refuses to allow doctors to treat persons believed to be opposed to a government, or fails to provide immunization against the community’s major infectious diseases, on grounds such as national security or the preservation of public order, has the burden of justifying such serious measures in relation to each of the elements identified in article 4. Such restrictions must be in accordance with the law, including international human rights standards, compatible with the nature of the rights protected by the Covenant, in the interest of legitimate aims pursued, and strictly necessary for the promotion of the general welfare in a democratic society.

29. In line with article 5.1, such limitations must be proportional, i.e. the least restrictive alternative must be adopted where several types of limitations are available. Even where such limitations on grounds of protecting public health are basically permitted, they should be of limited duration and subject to review.


General legal obligations

30. While the Covenant provides for progressive realization and acknowledges the constraints due to the limits of available resources, it also imposes on States parties various obligations which are of immediate effect. States parties have immediate obligations in relation to the right to health, such as the guarantee that the right will be exercised without discrimination of any kind (art. 2.2) and the obligation to take steps (art. 2.1) towards the full realization of article 12. Such steps must be deliberate, concrete and targeted towards the full realization of the right to health. (20)

31. The progressive realization of the right to health over a period of time should not be interpreted as depriving States parties’ obligations of all meaningful content. Rather, progressive realization means that States parties have a specific and continuing obligation to move as expeditiously and effectively as possible towards the full realization of article 12. (21)

32. As with all other rights in the Covenant, there is a strong presumption that retrogressive measures taken in relation to the right to health are not permissible. If any deliberately retrogressive measures are taken, the State party has the burden of proving that they have been introduced after the most careful consideration of all alternatives and that they are duly justified by reference to the totality of the rights provided for in the Covenant in the context of the full use of the State party’s maximum available resources. (22)

33. The right to health, like all human rights, imposes three types or levels of obligations on States parties: the obligations to respect, protect and fulfil. In turn, the obligation to fulfil contains obligations to facilitate, provide and promote. (23) The obligation to respect requires States to refrain from interfering directly or indirectly with the enjoyment of the right to health. The obligation to protect requires States to take measures that prevent third parties from interfering with article 12 guarantees. Finally, the obligation to fulfil requires States to adopt appropriate legislative, administrative, budgetary, judicial, promotional and other measures towards the full realization of the right to health.

Specific legal obligations

34. In particular, States are under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons, including prisoners or detainees, minorities, asylum seekers and illegal immigrants, to preventive, curative and palliative health services; abstaining from enforcing discriminatory practices as a State policy; and abstaining from imposing discriminatory practices relating to women’s health status and needs. Furthermore, obligations to respect include a State’s obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments, unless on an exceptional basis for the treatment of mental illness or the prevention and control of communicable diseases. Such exceptional cases should be subject to specific and restrictive conditions, respecting best practices and applicable international standards, including the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care. (24)

In addition, States should refrain from limiting access to contraceptives and other means of maintaining sexual and reproductive health, from censoring, withholding or intentionally misrepresenting health-related information, including sexual education and information, as well as from preventing people’s participation in health-related matters. States should also refrain from unlawfully polluting air, water and soil, e.g. through industrial waste from State-owned facilities, from using or testing nuclear, biological or chemical weapons if such testing results in the release of substances harmful to human health, and from limiting access to health services as a punitive measure, e.g. during armed conflicts in violation of international humanitarian law.

35. Obligations to protect include, inter alia, the duties of States to adopt legislation or to take other measures ensuring equal access to health care and health-related services provided by third parties; to ensure that privatization of the health sector does not constitute a threat to the availability, accessibility, acceptability and quality of health facilities, goods and services; to control the marketing of medical equipment and medicines by third parties; and to ensure that medical practitioners and other health professionals meet appropriate standards of education, skill and ethical codes of conduct. States are also obliged to ensure that harmful social or traditional practices do not interfere with access to pre- and post-natal care and family-planning; to prevent third parties from coercing women to undergo traditional practices, e.g. female genital mutilation; and to take measures to protect all vulnerable or marginalized groups of society, in particular women, children, adolescents and older persons, in the light of gender-based expressions of violence. States should also ensure that third parties do not limit people’s access to health-related information and services.

36. The obligation to fulfil requires States parties, inter alia, to give sufficient recognition to the right to health in the national political and legal systems, preferably by way of legislative implementation, and to adopt a national health policy with a detailed plan for realizing the right to health. States must ensure provision of health care, including immunization programmes against the major infectious diseases, and ensure equal access for all to the underlying determinants of health, such as nutritiously safe food and potable drinking water, basic sanitation and adequate housing and living conditions. Public health infrastructures should provide for sexual and reproductive health services, including safe motherhood, particularly in rural areas. States have to ensure the appropriate training of doctors and other medical personnel, the provision of a sufficient number of hospitals, clinics and other health-related facilities, and the promotion and support of the establishment of institutions providing counselling and mental health services, with due regard to equitable distribution throughout the country. Further obligations include the provision of a public, private or mixed health insurance system which is affordable for all, the promotion of medical research and health education, as well as information campaigns, in particular with respect to HIV/AIDS, sexual and reproductive health, traditional practices, domestic violence, the abuse of alcohol and the use of cigarettes, drugs and other harmful substances. States are also required to adopt measures against environmental and occupational health hazards and against any other threat as demonstrated by epidemiological data. For this purpose they should formulate and implement national policies aimed at reducing and eliminating pollution of air, water and soil, including pollution by heavy metals such as lead from gasoline. Furthermore, States parties are required to formulate, implement and periodically review a coherent national policy to minimize the risk of occupational accidents and diseases, as well as to provide a coherent national policy on occupational safety and health services. (25)

37. The obligation to fulfil (facilitate) requires States inter alia to take positive measures that enable and assist individuals and communities to enjoy the right to health. States parties are also obliged to fulfil (provide) a specific right contained in the Covenant when individuals or a group are unable, for reasons beyond their control, to realize that right themselves by the means at their disposal. The obligation to fulfil (promote) the right to health requires States to undertake actions that create, maintain and restore the health of the population. Such obligations include: (i) fostering recognition of factors favouring positive health results, e.g. research and provision of information; (ii) ensuring that health services are culturally appropriate and that health care staff are trained to recognize and respond to the specific needs of vulnerable or marginalized groups; (iii) ensuring that the State meets its obligations in the dissemination of appropriate information relating to healthy lifestyles and nutrition, harmful traditional practices and the availability of services; (iv) supporting people in making informed choices about their health.

International obligations

38. In its General Comment No. 3, the Committee drew attention to the obligation of all States parties to take steps, individually and through international assistance and cooperation, especially economic and technical, towards the full realization of the rights recognized in the Covenant, such as the right to health. In the spirit of article 56 of the Charter of the United Nations, the specific provisions of the Covenant (articles 12, 2.1, 22 and 23) and the Alma-Ata Declaration on primary health care, States parties should recognize the essential role of international cooperation and comply with their commitment to take joint and separate action to achieve the full realization of the right to health. In this regard, States parties are referred to the Alma-Ata Declaration which proclaims that the existing gross inequality in the health status of the people, particularly between developed and developing countries, as well as within countries, is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. (26)

39. To comply with their international obligations in relation to article 12, States parties have to respect the enjoyment of the right to health in other countries, and to prevent third parties from violating the right in other countries, if they are able to influence these third parties by way of legal or political means, in accordance with the Charter of the United Nations and applicable international law. Depending on the availability of resources, States should facilitate access to essential health facilities, goods and services in other countries, wherever possible and provide the necessary aid when required. (27) States parties should ensure that the right to health is given due attention in international agreements and, to that end, should consider the development of further legal instruments. In relation to the conclusion of other international agreements, States parties should take steps to ensure that these instruments do not adversely impact upon the right to health. Similarly, States parties have an obligation to ensure that their actions as members of international organizations take due account of the right to health. Accordingly, States parties which are members of international financial institutions, notably the International Monetary Fund, the World Bank, and regional development banks, should pay greater attention to the protection of the right to health in influencing the lending policies, credit agreements and international measures of these institutions.

40. States parties have a joint and individual responsibility, in accordance with the Charter of the United Nations and relevant resolutions of the United Nations General Assembly and of the World Health Assembly, to cooperate in providing disaster relief and humanitarian assistance in times of emergency, including assistance to refugees and internally displaced persons. Each State should contribute to this task to the maximum of its capacities. Priority in the provision of international medical aid, distribution and management of resources, such as safe and potable water, food and medical supplies, and financial aid should be given to the most vulnerable or marginalized groups of the population. Moreover, given that some diseases are easily transmissible beyond the frontiers of a State, the international community has a collective responsibility to address this problem. The economically developed States parties have a special responsibility and interest to assist the poorer developing States in this regard.

41. States parties should refrain at all times from imposing embargoes or similar measures restricting the supply of another State with adequate medicines and medical equipment. Restrictions on such goods should never be used as an instrument of political and economic pressure. In this regard, the Committee recalls its position, stated in General Comment No. 8, on the relationship between economic sanctions and respect for economic, social and cultural rights.

42. While only States are parties to the Covenant and thus ultimately accountable for compliance with it, all members of society – individuals, including health professionals, families, local communities, intergovernmental and non-governmental organizations, civil society organizations, as well as the private business sector – have responsibilities regarding the realization of the right to health. State parties should therefore provide an environment which facilitates the discharge of these responsibilities.

Core obligations

43. In General Comment No. 3, the Committee confirms that States parties have a core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights enunciated in the Covenant, including essential primary health care. Read in conjunction with more contemporary instruments, such as the Programme of Action of the International Conference on Population and Development, (28) the Alma-Ata Declaration provides compelling guidance on the core obligations arising from article 12. Accordingly, in the Committee’s view, these core obligations include at least the following obligations:

(a) To ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups;

(b) To ensure access to the minimum essential food which is nutritionally adequate and safe, to ensure freedom from hunger to everyone;

(c) To ensure access to basic shelter, housing and sanitation, and an adequate supply of safe and potable water;

(d) To provide essential drugs, as from time to time defined under the WHO Action Programme on Essential Drugs;

(e) To ensure equitable distribution of all health facilities, goods and services;

(f) To adopt and implement a national public health strategy and plan of action, on the basis of epidemiological evidence, addressing the health concerns of the whole population; the strategy and plan of action shall be devised, and periodically reviewed, on the basis of a participatory and transparent process; they shall include methods, such as right to health indicators and benchmarks, by which progress can be closely monitored; the process by which the strategy and plan of action are devised, as well as their content, shall give particular attention to all vulnerable or marginalized groups.

44. The Committee also confirms that the following are obligations of comparable priority:

(a) To ensure reproductive, maternal (pre-natal as well as post-natal) and child health care;

(b) To provide immunization against the major infectious diseases occurring in the community;

(c) To take measures to prevent, treat and control epidemic and endemic diseases;

(d) To provide education and access to information concerning the main health problems in the community, including methods of preventing and controlling them;

(e) To provide appropriate training for health personnel, including education on health and human rights.

45. For the avoidance of any doubt, the Committee wishes to emphasize that it is particularly incumbent on States parties and other actors in a position to assist, to provide “international assistance and cooperation, especially economic and technical” (29) which enable developing countries to fulfil their core and other obligations indicated in paragraphs 43 and 44 above.


46. When the normative content of article 12 (Part I) is applied to the obligations of States parties (Part II), a dynamic process is set in motion which facilitates identification of violations of the right to health. The following paragraphs provide illustrations of violations of article 12.

47. In determining which actions or omissions amount to a violation of the right to health, it is important to distinguish the inability from the unwillingness of a State party to comply with its obligations under article 12. This follows from article 12.1, which speaks of the highest attainable standard of health, as well as from article 2.1 of the Covenant, which obliges each State party to take the necessary steps to the maximum of its available resources. A State which is unwilling to use the maximum of its available resources for the realization of the right to health is in violation of its obligations under article 12. If resource constraints render it impossible for a State to comply fully with its Covenant obligations, it has the burden of justifying that every effort has nevertheless been made to use all available resources at its disposal in order to satisfy, as a matter of priority, the obligations outlined above. It should be stressed, however, that a State party cannot, under any circumstances whatsoever, justify its non-compliance with the core obligations set out in paragraph 43 above, which are non-derogable.

48. Violations of the right to health can occur through the direct action of States or other entities insufficiently regulated by States. The adoption of any retrogressive measures incompatible with the core obligations under the right to health, outlined in paragraph 43 above, constitutes a violation of the right to health. Violations through acts of commission include the formal repeal or suspension of legislation necessary for the continued enjoyment of the right to health or the adoption of legislation or policies which are manifestly incompatible with pre-existing domestic or international legal obligations in relation to the right to health.

49. Violations of the right to health can also occur through the omission or failure of States to take necessary measures arising from legal obligations. Violations through acts of omission include the failure to take appropriate steps towards the full realization of everyone’s right to the enjoyment of the highest attainable standard of physical and mental health, the failure to have a national policy on occupational safety and health as well as occupational health services, and the failure to enforce relevant laws.

Violations of the obligation to respect

50. Violations of the obligation to respect are those State actions, policies or laws that contravene the standards set out in article 12 of the Covenant and are likely to result in bodily harm, unnecessary morbidity and preventable mortality. Examples include the denial of access to health facilities, goods and services to particular individuals or groups as a result of de jure or de facto discrimination; the deliberate withholding or misrepresentation of information vital to health protection or treatment; the suspension of legislation or the adoption of laws or policies that interfere with the enjoyment of any of the components of the right to health; and the failure of the State to take into account its legal obligations regarding the right to health when entering into bilateral or multilateral agreements with other States, international organizations and other entities, such as multinational corporations.

Violations of the obligation to protect

51. Violations of the obligation to protect follow from the failure of a State to take all necessary measures to safeguard persons within their jurisdiction from infringements of the right to health by third parties. This category includes such omissions as the failure to regulate the activities of individuals, groups or corporations so as to prevent them from violating the right to health of others; the failure to protect consumers and workers from practices detrimental to health, e.g. by employers and manufacturers of medicines or food; the failure to discourage production, marketing and consumption of tobacco, narcotics and other harmful substances; the failure to protect women against violence or to prosecute perpetrators; the failure to discourage the continued observance of harmful traditional medical or cultural practices; and the failure to enact or enforce laws to prevent the pollution of water, air and soil by extractive and manufacturing industries.

Violations of the obligation to fulfil

52. Violations of the obligation to fulfil occur through the failure of States parties to take all necessary steps to ensure the realization of the right to health. Examples include the failure to adopt or implement a national health policy designed to ensure the right to health for everyone; insufficient expenditure or misallocation of public resources which results in the non-enjoyment of the right to health by individuals or groups, particularly the vulnerable or marginalized; the failure to monitor the realization of the right to health at the national level, for example by identifying right to health indicators and benchmarks; the failure to take measures to reduce the inequitable distribution of health facilities, goods and services; the failure to adopt a gender-sensitive approach to health; and the failure to reduce infant and maternal mortality rates.


Framework legislation

53. The most appropriate feasible measures to implement the right to health will vary significantly from one State to another. Every State has a margin of discretion in assessing which measures are most suitable to meet its specific circumstances. The Covenant, however, clearly imposes a duty on each State to take whatever steps are necessary to ensure that everyone has access to health facilities, goods and services so that they can enjoy, as soon as possible, the highest attainable standard of physical and mental health. This requires the adoption of a national strategy to ensure to all the enjoyment of the right to health, based on human rights principles which define the objectives of that strategy, and the formulation of policies and corresponding right to health indicators and benchmarks. The national health strategy should also identify the resources available to attain defined objectives, as well as the most cost-effective way of using those resources.

54. The formulation and implementation of national health strategies and plans of action should respect, inter alia, the principles of non-discrimination and people’s participation. In particular, the right of individuals and groups to participate in decision-making processes, which may affect their development, must be an integral component of any policy, programme or strategy developed to discharge governmental obligations under article 12. Promoting health must involve effective community action in setting priorities, making decisions, planning, implementing and evaluating strategies to achieve better health. Effective provision of health services can only be assured if people’s participation is secured by States.

55. The national health strategy and plan of action should also be based on the principles of accountability, transparency and independence of the judiciary, since good governance is essential to the effective implementation of all human rights, including the realization of the right to health. In order to create a favourable climate for the realization of the right, States parties should take appropriate steps to ensure that the private business sector and civil society are aware of, and consider the importance of, the right to health in pursuing their activities.

56. States should consider adopting a framework law to operationalize their right to health national strategy. The framework law should establish national mechanisms for monitoring the implementation of national health strategies and plans of action. It should include provisions on the targets to be achieved and the time-frame for their achievement; the means by which right to health benchmarks could be achieved; the intended collaboration with civil society, including health experts, the private sector and international organizations; institutional responsibility for the implementation of the right to health national strategy and plan of action; and possible recourse procedures. In monitoring progress towards the realization of the right to health, States parties should identify the factors and difficulties affecting implementation of their obligations.

Right to health indicators and benchmarks

57. National health strategies should identify appropriate right to health indicators and benchmarks. The indicators should be designed to monitor, at the national and international levels, the State party’s obligations under article 12. States may obtain guidance on appropriate right to health indicators, which should address different aspects of the right to health, from the ongoing work of WHO and the United Nations Children’s Fund (UNICEF) in this field. Right to health indicators require disaggregation on the prohibited grounds of discrimination.

58. Having identified appropriate right to health indicators, States parties are invited to set appropriate national benchmarks in relation to each indicator. During the periodic reporting procedure the Committee will engage in a process of scoping with the State party. Scoping involves the joint consideration by the State party and the Committee of the indicators and national benchmarks which will then provide the targets to be achieved during the next reporting period. In the following five years, the State party will use these national benchmarks to help monitor its implementation of article 12. Thereafter, in the subsequent reporting process, the State party and the Committee will consider whether or not the benchmarks have been achieved, and the reasons for any difficulties that may have been encountered.

Remedies and accountability

59. Any person or group victim of a violation of the right to health should have access to effective judicial or other appropriate remedies at both national and international levels. (30) All victims of such violations should be entitled to adequate reparation, which may take the form of restitution, compensation, satisfaction or guarantees of non-repetition. National ombudsmen, human rights commissions, consumer forums, patients’ rights associations or similar institutions should address violations of the right to health.

60. The incorporation in the domestic legal order of international instruments recognizing the right to health can significantly enhance the scope and effectiveness of remedial measures and should be encouraged in all cases. (31) Incorporation enables courts to adjudicate violations of the right to health, or at least its core obligations, by direct reference to the Covenant.

61. Judges and members of the legal profession should be encouraged by States parties to pay greater attention to violations of the right to health in the exercise of their functions.

62. States parties should respect, protect, facilitate and promote the work of human rights advocates and other members of civil society with a view to assisting vulnerable or marginalized groups in the realization of their right to health.


63. The role of the United Nations agencies and programmes, and in particular the key function assigned to WHO in realizing the right to health at the international, regional and country levels, is of particular importance, as is the function of UNICEF in relation to the right to health of children. When formulating and implementing their right to health national strategies, States parties should avail themselves of technical assistance and cooperation of WHO. Further, when preparing their reports, States parties should utilize the extensive information and advisory services of WHO with regard to data collection, disaggregation, and the development of right to health indicators and benchmarks.

64. Moreover, coordinated efforts for the realization of the right to health should be maintained to enhance the interaction among all the actors concerned, including the various components of civil society. In conformity with articles 22 and 23 of the Covenant, WHO, The International Labour Organization, the United Nations Development Programme, UNICEF, the United Nations Population Fund, the World Bank, regional development banks, the International Monetary Fund, the World Trade Organization and other relevant bodies within the United Nations system, should cooperate effectively with States parties, building on their respective expertise, in relation to the implementation of the right to health at the national level, with due respect to their individual mandates. In particular, the international financial institutions, notably the World Bank and the International Monetary Fund, should pay greater attention to the protection of the right to health in their lending policies, credit agreements and structural adjustment programmes. When examining the reports of States parties and their ability to meet the obligations under article 12, the Committee will consider the effects of the assistance provided by all other actors. The adoption of a human rights-based approach by United Nations specialized agencies, programmes and bodies will greatly facilitate implementation of the right to health. In the course of its examination of States parties’ reports, the Committee will also consider the role of health professional associations and other non-governmental organizations in relation to the States’ obligations under article 12.

65. The role of WHO, the Office of the United Nations High Commissioner for Refugees, the International Committee of the Red Cross/Red Crescent and UNICEF, as well as non governmental organizations and national medical associations, is of particular importance in relation to disaster relief and humanitarian assistance in times of emergencies, including assistance to refugees and internally displaced persons. Priority in the provision of international medical aid, distribution and management of resources, such as safe and potable water, food and medical supplies, and financial aid should be given to the most vulnerable or marginalized groups of the population.

Adopted on 11 May 2000.


1. For example, the principle of non-discrimination in relation to health facilities, goods and services is legally enforceable in numerous national jurisdictions.

2. In its resolution 1989/11.

3. The Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care adopted by the United Nations General Assembly in 1991 (resolution 46/119) and the Committee’s General Comment No. 5 on persons with disabilities apply to persons with mental illness; the Programme of Action of the International Conference on Population and Development held at Cairo in 1994, as well as the Declaration and Programme for Action of the Fourth World Conference on Women held in Beijing in 1995 contain definitions of reproductive health and women’s health, respectively.

4. Common article 3 of the Geneva Conventions for the protection of war victims (1949); Additional Protocol I (1977) relating to the Protection of Victims of International Armed Conflicts, art. 75 (2) (a); Additional Protocol II (1977) relating to the Protection of Victims of Non-International Armed Conflicts, art. 4 (a).

5. See WHO Model List of Essential Drugs, revised December 1999, WHO Drug Information, vol. 13, No. 4, 1999.

6. Unless expressly provided otherwise, any reference in this General Comment to health facilities, goods and services includes the underlying determinants of health outlined in paras. 11 and 12 (a) of this General Comment.

7. See paras. 18 and 19 of this General Comment.

8. See article 19.2 of the International Covenant on Civil and Political Rights. This General Comment gives particular emphasis to access to information because of the special importance of this issue in relation to health.

9. In the literature and practice concerning the right to health, three levels of health care are frequently referred to: primary health care typically deals with common and relatively minor illnesses and is provided by health professionals and/or generally trained doctors working within the community at relatively low cost; secondary health care is provided in centres, usually hospitals, and typically deals with relatively common minor or serious illnesses that cannot be managed at community level, using specialty-trained health professionals and doctors, special equipment and sometimes in-patient care at comparatively higher cost; tertiary health care is provided in relatively few centres, typically deals with small numbers of minor or serious illnesses requiring specialty-trained health professionals and doctors and special equipment, and is often relatively expensive. Since forms of primary, secondary and tertiary health care frequently overlap and often interact, the use of this typology does not always provide sufficient distinguishing criteria to be helpful for assessing which levels of health care States parties must provide, and is therefore of limited assistance in relation to the normative understanding of article 12.

10. According to WHO, the stillbirth rate is no longer commonly used, infant and under-five mortality rates being measured instead.

11. Prenatal denotes existing or occurring before birth; perinatal refers to the period shortly before and after birth (in medical statistics the period begins with the completion of 28 weeks of gestation and is variously defined as ending one to four weeks after birth); neonatal, by contrast, covers the period pertaining to the first four weeks after birth; while post-natal denotes occurrence after birth. In this General Comment, the more generic terms pre- and post-natal are exclusively employed.

12. Reproductive health means that women and men have the freedom to decide if and when to reproduce and the right to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice as well as the right of access to appropriate health-care services that will, for example, enable women to go safely through pregnancy and childbirth.

13. The Committee takes note, in this regard, of Principle 1 of the Stockholm Declaration of 1972 which states: “Man has the fundamental right to freedom, equality and adequate conditions of life, in an environment of a quality that permits a life of dignity and well-being”, as well as of recent developments in international law, including General Assembly resolution 45/94 on the need to ensure a healthy environment for the well-being of individuals; Principle 1 of the Rio Declaration; and regional human rights instruments such as article 10 of the San Salvador Protocol to the American Convention on Human Rights.

14. ILO Convention No. 155, art. 4.2.

15. See para. 12 (b) and note 8 above.

16. For the core obligations, see paras. 43 and 44 of the present General Comments.

17. Article 24.1 of the Convention on the Rights of the Child.

18. See World Health Assembly resolution WHA47.10, 1994, entitled “Maternal and child health and family planning: traditional practices harmful to the health of women and children”.

19. Recent emerging international norms relevant to indigenous peoples include the ILO Convention No. 169 concerning Indigenous and Tribal Peoples in Independent Countries (1989); articles 29 (c) and (d) and 30 of the Convention on the Rights of the Child (1989); article 8 (j) of the Convention on Biological Diversity (1992), recommending that States respect, preserve and maintain knowledge, innovation and practices of indigenous communities; Agenda 21 of the United Nations Conference on Environment and Development (1992), in particular chapter 26; and Part I, paragraph 20, of the Vienna Declaration and Programme of Action (1993), stating that States should take concerted positive steps to ensure respect for all human rights of indigenous people, on the basis of non-discrimination. See also the preamble and article 3 of the United Nations Framework Convention on Climate Change (1992); and article 10 (2) (e) of the United Nations Convention to Combat Desertification in Countries Experiencing Serious Drought and/or Desertification, Particularly in Africa (1994). During recent years an increasing number of States have changed their constitutions and introduced legislation recognizing specific rights of indigenous peoples.

20. See General Comment No. 13, para. 43.

21. See General Comment No. 3, para. 9; General Comment No. 13, para. 44.

22. See General Comment No. 3, para. 9; General Comment No. 13, para. 45.

23. According to General Comments Nos. 12 and 13, the obligation to fulfil incorporates an obligation to facilitate and an obligation to provide. In the present General Comment, the obligation to fulfil also incorporates an obligation to promote because of the critical importance of health promotion in the work of WHO and elsewhere.

24. General Assembly resolution 46/119 (1991).

25. Elements of such a policy are the identification, determination, authorization and control of dangerous materials, equipment, substances, agents and work processes; the provision of health information to workers and the provision, if needed, of adequate protective clothing and equipment; the enforcement of laws and regulations through adequate inspection; the requirement of notification of occupational accidents and diseases, the conduct of inquiries into serious accidents and diseases, and the production of annual statistics; the protection of workers and their representatives from disciplinary measures for actions properly taken by them in conformity with such a policy; and the provision of occupational health services with essentially preventive functions. See ILO Occupational Safety and Health Convention, 1981 (No. 155) and Occupational Health Services Convention, 1985 (No. 161).

26. Article II, Alma-Ata Declaration, Report of the International Conference on Primary Health Care, Alma-Ata, 6-12 September 1978, in: World Health Organization, “Health for All” Series, No. 1, WHO, Geneva, 1978.

27. See para. 45 of this General Comment.

28. Report of the International Conference on Population and Development, Cairo, 5-13 September 1994 (United Nations publication, Sales No. E.95.XIII.18), chap. I, resolution 1, annex, chaps. VII and VIII.

29. Covenant, art. 2.1.

30. Regardless of whether groups as such can seek remedies as distinct holders of rights, States parties are bound by both the collective and individual dimensions of article 12. Collective rights are critical in the field of health; modern public health policy relies heavily on prevention and promotion which are approaches directed primarily to groups.

31. See General Comment No. 2, para. 9.

Truth – Justice – Peace