The Ukraine war, with disease and destruction following in its wake, loomed large Sunday as the WHO convened countries to address a still raging pandemic and a vast array of other global health challenges.
"Where war goes, hunger and disease follow shortly behind," World Health Organization chief Tedros Adhanom Ghebreyesus warned on the opening day of the U.N. agency's main annual assembly.
The assembly, due to run through Saturday, marks the first time the WHO is convening its 194 member states for their first largely in-person gathering since COVID-19 surfaced in late 2019.
Tedros warned that important work at the assembly to address a long line of global health emergencies and challenges, including the COVID-19 crisis, could not succeed "in a divided world."
"We face a formidable convergence of disease, drought, famine and war, fueled by climate change, inequity and geopolitical rivalry,” he warned.
The former Ethiopian health minister said he was viewing the ravages in Ukraine through a personal lens: "I am a child of war.”
In Ukraine and elsewhere, he said, it is clear peace "is a prerequisite for health. We must choose health for peace, and peace, peace, peace."
But it was war that dominated the high-level speeches on the first day of the assembly.
"The consequences of this war are devastating, to health, to populations, to health facilities and to health personnel," French President Emmanuel Macron said in a video address.
He called on all member states to support a resolution to be presented by Ukraine and discussed by the assembly Tuesday, which harshly condemns Russia's invasion, especially its more than 200 attacks on health care providers, including hospitals and ambulances, in Ukraine.
The resolution will also voice alarm at the "health emergency in Ukraine," and highlight the dire impacts beyond its borders, including how disrupted grain exports are deepening a global food security crisis.
But while Russia has been shunned and pushed out of other international bodies over its invasion, no such sanctions are foreseen at the World Health Assembly.
"There's not a call to kick them out," a Western diplomat told AFP, acknowledging the sanctions permitted under WHO rules are "very weak."
The Ukraine conflict is far from the only health emergency up for discussion this week, with decisions expected on a range of important issues, including on reforms toward strengthening pandemic preparedness.
"This meeting is a historic opportunity to strengthen universal architecture for security and health," Dominican Republic President Luis Abinader Corona told the assembly.
Among the decisions expected at the assembly is Tedros's reappointment to a second five-year term.
His first term was turbulent, as he helped steer the global response to the pandemic and grappled with other crises, including a sexual abuse scandal involving WHO staff in the Democratic Republic of Congo.
But while he has faced his share of criticism, he has received broad backing and is running unopposed, guaranteeing him a second term.
There will be no shortage of challenges ahead, with the COVID-19 pandemic still raging and demands for dramatic reforms of the entire global health system to help avert similar threats in the future.
And new health menaces already loom, including hepatitis of mysterious origin that has made children in many countries ill, and swelling numbers of monkeypox cases far from Central and West Africa —where the disease is normally concentrated.
One of the major reforms up for discussion involves the WHO budget, with countries expected to greenlight a plan to boost secure and flexible funding to ensure the organization can respond quickly to global health threats.
The WHO's two-year budget for 2020-21 ticked in at $5.8 billion, but only 16% of that came from regular membership fees.
The idea is to gradually raise the membership fee portion to 50% over nearly a decade, while WHO will be expected to implement reforms, which includes more transparency on its financing and hiring.
The remainder came from voluntary contributions that are heavily earmarked by countries for specific projects.
"There is no greater return on investment than health," U.N. chief Antonio Guterres told the assembly in a video address.
The COVID pandemic laid bare major deficiencies in the global health system, and countries last year agreed numerous changes were needed to better prepare the world to face future pandemic threats.
Amendments are being considered to the International Health Regulations — a set of legally binding international laws governing how countries respond to acute public health risks.
And negotiations are underway toward a new "legal instrument" — possibly a treaty— aimed at streamlining the global approach to pandemic preparedness and response.But experts warn the reform process is moving too slowly.
Former New Zealand Prime Minister Helen Clark, who co-chaired an expert panel on pandemic preparedness, warned reporters last week little had changed.
"At its current pace, an effective system is still years away, when a pandemic threat could occur at any time,” Clark said.