Hanan Balki has a lot to do these days.
Mr Balki is the World Health Organization’s regional director for the Eastern Mediterranean. The region includes several countries involved in the conflict between the United States, Israel, and Iran. The challenges posed not only to personal health and safety, but to the health care system as a whole, are stealing her sleep.
Balki is also one of the names that will be mentioned when jaws start buzzing about who will be chosen as the next director-general of the WHO. Current director-general Tedros Adhanom Ghebreyesus’ second and final term ends in the summer of 2027, but the process to select his successor is expected to formally begin later this month or in May, when Tedros will solicit nominations.
The nomination period ends in September or October, so Balki still has time to decide whether to be a candidate. However, the reality is that she will have to make the difficult decision that she may need to take administrative leave from her current role at a very difficult time for the region.
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In a recent interview with STAT, Balki spoke about her thoughts on entering the race, the challenges Washington will pose to those vying to be the next director-general, and the challenges her organization, known in WHO circles as EMRO, faces because of the Iran war and other wars.
First, some background on Balkhy. She is a pediatrician from Saudi Arabia who studied at King Abdulaziz University, completed a pediatric residency at Massachusetts General Hospital, and completed pediatric infectious disease fellowships at the Cleveland Clinic Foundation and Case Western Reserve University. Prior to her election as EMRO Regional Director in early 2024, she served as WHO’s Deputy Director-General for Antimicrobial Resistance for approximately five years.
This interview was conducted before the ceasefire was announced last week and has been lightly edited for length and clarity.
First of all, could you give us some basic information? Your home country is Saudi Arabia, right?
Yes, certainly.
You studied abroad in America. Do you have dual citizenship?
yes. Actually, I was born in America. But I’m Saudi.
The process to select a new WHO Director-General will begin soon. You have been named as a candidate to become the next commander-in-chief. Do you want to?
I don’t think it’s 100% clear to me as a runner at this point. I live in a very busy area and am very focused on my current job.
There is talk that EMRO may take the position of Director-General this time. I understand that positions are not officially swapped between WHO regions, but if there is such a feeling, I think there may be pressure to step into the ring.
Two regions that have not had a Director-General so far are EMRO and SEARO (WHO’s South-East Asia Regional Organization). But I think it’s a bit of a gentleman’s agreement.
Do you have a goal in mind by when you need to decide? Midsummer? Or maybe there’s so much going on that you should probably play it by ear?
I think it’s definitely the latter. There’s a lot going on. And really, if we were to run for any regional director, I think we can only make our candidacy better by doing the job that we’re doing well.
Global health experts predict that nominees for director-general will likely feel the need to travel to Washington to meet with administration officials, even though the United States has officially left the WHO and has no voting rights.
Any thoughts on that? That can be a big deal. Other countries may be outraged to see candidates bowing down to DC at this point.
Because of its talent, scientific acumen, scientists, US CDC, NIH, and academia, the US is a country of great value to global public health in general. And for all of us, it was really difficult to see the United States leave.
Of course, people have to go to the United States, Washington DC, Beijing. We have to go everywhere and always keep communication open. If you don’t communicate, you’ll only be missing out.
We want America back. We want all Member States to be at the table. Yes, that’s right. And I’d bet a million dollars that every candidate will do it, whether they say it or not.
Let’s talk about your area. The effects of what’s happening there are being felt all over the world, but nowhere more so than in your area. Of the many concerns you should have, what is your biggest concern?
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What I fear at this point is further escalation to full-scale nuclear, biological, or chemical warfare. That’s what keeps me up at night.
That is why we are doing everything we can to ensure that we are fully prepared to provide the support that our member states in the region need, and to maintain good communication with the rest of the region. Because of the 21 countries involved in this current conflict, 16 or 17 are members of EMRO, and several others are within the EURO area. (Editor’s note: Although Israel is located in the Middle East, it is part of the WHO European region.)
My second concern is that this could lead to attacks on desalination plants. This would be an utter disaster. Between 70% and 100% of some countries in the region are completely dependent on desalination plants. This means that if they are attacked, they have no water to drink, cook with, or grow crops.
If that were to happen, the immediate effect would be mass immigration. So you’re talking about chaos, crowding, displaced people. There are already 3.2 million displaced people in Iran and more than 1 million in Lebanon. One in seven people in this region of 750 million people already requires humanitarian assistance.
Dubai has the most important humanitarian centers. Much of the emergency kit and aid to countries in conflict is routed through the Dubai hub. And when airspace was closed, millions of dollars worth of medical supplies had to be stopped. It’s slowly coming back.
Has the airspace closure effectively shut down WHO’s emergency distribution system?
that’s right. We had to look for an alternative and that’s what we did. The UAE Government has worked very hard with us to ensure that these flights can continue as long as possible and to find alternative routes. In addition to the closure of the Strait of Hormuz and the rising cost of energy such as gas and oil.
For the past month or so, I’ve been living my life thinking about all these complexities.
I know I’m running out of time. Is there something you’d like us to cover that we’re not talking about? Do you want to shine a light on something that doesn’t get enough attention in the global health space?
As EMRO’s Regional Director, I am mindful of the debate around the global health architecture and how its restructuring will address long-term issues and health emergencies.
Things take time. If you want to build a truly robust system, you need to invest even in the midst of a humanitarian response.
