Vulnerable populations need protection in an age of impunity

The global health community is facing a pivotal moment as it struggles to respond to increasingly complex, interrelated challenges.1 Factors including the climate crisis, conflict, and political instability are driving large scale population displacement as global institutional frameworks are weakening. International norms are being eroded. This is evident in the targeting of education and healthcare infrastructure in conflict zones,2 shrinking space for humanitarian work, denial of due process to migrants and displaced populations,34 and disregard for international law—all of which contribute to a climate of impunity.

This erosion of international norms undermines the foundations of society, weakens the multilateral system, and worsens health inequalities. The most vulnerable, including migrants, refugees, undocumented and stateless people, and those in conflict zones, are at the greatest risk of harm. Decisive, coordinated, and principled action is needed from those who are committed to preserving human rights and international order.

We are watching the normalisation of actions that once drew widespread condemnation. The Geneva Conventions and international humanitarian law are being ignored, and the courts (whose duty it is to uphold them) are being attacked.5 Journalists are being targeted,6 and what information does emerge from conflict zones is selectively reported or strictly controlled. Evidence of atrocities is disputed, even when it comes from independent sources, and victims are blamed for their own misfortune. All lives are not treated equally.7 These are not isolated incidents but part of a broader, systemic erosion of international humanitarian law and multilateral principles. When such norms are violated without consequence, the burden falls heaviest on people who are already at society’s margins.

In this global context, migration and displacement have reached record levels. Yet, the most vulnerable migrant, refugee, and stateless populations often remain largely invisible in health data and policy responses. These populations are systematically excluded from national surveillance systems, budget planning, and policy agendas. This exclusion is not by oversight, but by deliberate political choices that erase these populations from statistics and discourse. Without intentional inclusion, these communities remain voiceless and invisible in systems meant to protect their health.

The situation is worsening as the global health community faces the systematic defunding and deprioritisation of research, evidence generation, and rights based advocacy on migration and health.8 This retreat from decision making that is based on evidence enables neglect and ignorance, legitimises inaction, and deepens harm.9

Comprehensive and inclusive data systems and evidence generation are crucial for reducing health inequities, informing planning, and fulfilling legal and ethical obligations.10 Available data are a moral imperative because without them, governments and institutions cannot be held accountable for healthcare access or outcomes.11 Investing in inclusive, disaggregated data and well funded research is therefore foundational to justice and equity.12

Health professionals have a duty to promote participatory approaches that place the experiences of communities that are displaced, migrant, or affected by conflict at the centre of health and policy responses. Rather than being passive recipients of aid, or subjects of research, the experience and knowledge of these communities must be actively included in shaping the policies that affect their lives.13 Inclusion is not an act of charity—it is a matter of justice.

Especially in the current context, health professionals and institutions must move beyond neutrality and embrace their role as advocates for justice.14 Where there is structural violence and exclusion, silence amounts to complicity. The public health community, with its roots in evidence, ethics, and equity, has a moral and ethical duty to speak out. Health and politics are inextricably intertwined.5

At a time of declining global cooperation, the role of multilateral institutions and their guiding principles is critical. Organisations such as the World Health Organisation, other United Nations specialised agencies, international development bodies, and ministries of health must intensify their commitment to inclusive policies, evidence based guidance, and coordinated global action to support vulnerable populations. Multilateralism represents a vital foundation for the future of health and equity. Safeguarding the right to health for all requires a renewed dedication to global solidarity and shared responsibility.

Civil society organisations working in the health field face additional responsibilities too. In an era marked by selective empathy and geopolitical double standards, they must actively resist the marginalisation and erasure of vulnerable populations and speak out with moral clarity. These organisations must advocate for consistent, rights based action, even when such advocacy is politically inconvenient; and protect spaces for science, data, and truth.1415 This advocacy is particularly important in the face of censorship, denial, and political pressure. People whose health, dignity, and fundamental rights are threatened need unwavering solidarity.

The challenges confronting us are vast and complex, but so is our collective capacity for meaningful change. Reclaiming health equity in this era of impunity requires courage, moral conviction, and sustained collaboration. We need to centre marginalised voices, defend evidence based practices, uphold science, and hold those in power accountable. The global health community must meet this moment not with silence or neutrality, but with principled solidarity and action.