The M’Poko internally displaced people camp in the Central African Republic, where sex abuse by international peacekeepers apparently occurred in 2014. CATIANNE TIJERINA/UN PHOTO

The uproar over accusations that French soldiers assigned to peacekeeping had sexually abused about a dozen boys in the Central African Republic from late 2013 through mid-2014 has shifted focus from the apparent behavior of the soldiers to the role the United Nations played in dealing with the allegations. The French soldiers were not part of a UN peacekeeping mission.

This shift of attention leaves the French soldiers and other troops from African countries implicated in the case off the hook for the moment — France has yet to announce developments in the case, which it knew about almost a year ago. So how did the UN move from backstage to center stage so fast in the unfolding drama?

In April, The Guardian newspaper reported that a group of French soldiers, part of a national contingent dispatched in December 2013 to Bangui, the capital of the Central African Republic, to quell the murderous chaos there had been accused of bartering food for oral sex from local boys. Expressing surprise after the news account was published, both France and the UN announced separately that they were each investigating the matter.

Yet France and the UN higher-ups, it turns out, knew about the allegations ever since Anders Kompass, a UN human-rights expert who worked in Geneva, handed a confidential report to French officials in July 2014, to the consternation of the UN. He had obtained the report from a fellow colleague and gave it to the French a week or so after he got it.

Now, Kompass, a Swede, who has said he felt compelled to pass on the information to France in frustration over what he perceived as UN passivity, is being labeled both a whistleblower and a bad seed, depending on the camp calling the names.

Flavia Pansieri, the boss of Kompass in the UN Office of the High Commissioner for Human Rights, was told by her boss, Zeid Ra’ad al-Hussein, to suspend Kompass from his job for breaking protocol in leaking the unredacted report to the French and jeopardizing, the UN says, the privacy and security of the boys named in the report. The suspension of Kompass was reversed by a UN tribunal in early May.

Which is where the focus is stuck, with the UN bending over backwards, in its bureaucratic mode, to investigate whether the suspension of Kompass is legitimate. It is also consumed round the clock at its offices in Switzerland and headquarters in New York trying to deal with questions from the media and others as to why it seemed so derelict in following up on the case once UN officials learned about the accusations, which was in July 2014.

To the credit of the UN, which does not always manage the endless minor and major accusations lobbed against it with finesse, this time it is emphasizing that the French soldiers in the Central African Republic were not working for the UN.

That is where the narrative could be redirected. Instead, complicating matters, additional UN documents more recently leaked by AIDS-Free World, a nonprofit group based in the US that first leaked the information about Kompass and the alleged sex abuse to The Guardian, offer contrary versions about the UN report itself. Did the report contain the names of the victims or were those names fictionalized? Kompass has contended both.

As more UN documents on the matter have been leaked by AIDS-Free World, the status of the boys themselves has drawn little notice.

Thierry Delvigne-Jean, the Unicef communications chief for West and Central Africa, based in Senegal, told PassBlue in an email when the news was first reported in The Guardian that “UNICEF child protection specialists in the Central African Republic were part of a joint UN team, alongside human rights officers from MINUSCA, that in 2014 interviewed children who had reported being victims of sexual abuse. Information from those interviews was passed to MINUSCA.” (Minusca is the shorthand name of the UN peacekeeping mission in the Central African Republic, established in April 2014.)

“Subsequent to interviewing the children, UNICEF staff referred them to other partner agencies for psychological and other support,” Delvigne-Jean said. Not much more has been publicly heard from Unicef on the case, although on June 5, a spokesman for Unicef in Geneva confirmed that the UN report about sexual abuse was sent to Unicef’s headquarters in New York, which gave it to the UN’s office for children and armed conflict. That office has not publicly commented on the report.

Nowhere is it clear why UN officials, including Flavia Pansieri, the deputy high commissioner for human rights, would keep such damaging information about young boys’ lives secret, if that is the case.

Not much has been discussed, either, about the notoriously tricky nature of taking children’s testimony, especially about sex acts. The leaked documents show that six of the children, all boys, interviewed by the UN officials were done directly, while testimony from others was recorded through witnesses.

The rush to accuse the UN for negligence and ineptitude by various parties and many media has pushed Ban Ki-moon, the UN secretary-general, to announce this month that an outside team will investigate the handling of the sex-abuse claims in the Central African Republic, even though UN peacekeepers are not being blamed. The United States chimed in for the first time officially, saying it supports Ban’s move for a “full and impartial investigation” into the matter.

As Stepháne Dujarric, the UN secretary-general’s spokesman, said, “There are systems that failed here.”

The drama in the Central African Republic began in early December 2013, soon after French troops from Operation Sangaris (named after a local species of butterfly) flew to Bangui to help protect residents from the sudden mayhem that engulfed the capital and rural areas across the country, a conflict that pitted one raging group of militias against another based on religious and ethnic lines. In the days after the violence erupted, civilians were being slaughtered in killing sprees, including lynching in the capital.

The French, former colonizers of the country, arrived to restore a semblance of order in the city and soon at the airport, called M’poko, where thousands of civilians had camped for safety.

It is at the airport, crammed with people who had set up simple shelters to stay alive, where the sex abuse allegedly took place, at certain checkpoints operated by French peacekeepers. The abuse lasted from December until mid-2014, the UN report says, involving French soldiers as well as troops from Equatorial Guinea and Chad — 24 soldiers in total — extorting sex from boys as young as 9 years old for food.

Katarina Hoije, a Swedish freelance journalist based in Mali who was reporting from the Central African Republic from February to April 2014, described in an email to PassBlue that “the situation was extremely tense.” [The French soldiers were] “struggling to maintain a minimum of calm; finally they retreated to the airport. They were manning the checkpoints at the IDP camp, still armed anti-balaka walked in and out of the camp.” (The anti-balaka were one of the warring militias.)

“Children used to come up to the soldiers and ask for food or money. You would regularly see children, mainly young boys, selling French army rations in the camp and outside the airport. I was told they were given as payment for work or small services. Food distributions in the camp was a mess. People would constantly complain that they hadn’t been given food and they would take it out on the French soldiers who ignored or yell back.”

Occasionally, she added, the soldiers got aggressive, although she said she never saw them get physical, “but the way they treated people, especially women and children, wasn’t good.”

The French were criticized during this period for not intervening during some of the killing sprees in the streets of Bangui; instead, Chadian peacekeepers protected Muslims who were attacked, Hoije said, while Rwandans and Burundian peacekeepers (all sent as peacekeepers from the African Union) fended for other civilians.

The alleged sexual acts by French soldiers and the others were originally investigated by a UN human-rights staff member from Minusca (the UN peacekeeping mission in the Central African Republic), and at least one official from Unicef, the children’s specialized agency, on various dates from May to June 2014. The report reveals the boys telling the investigators that they had been forced into sex with soldiers for such basics as biscuits. The boys, many of them orphaned or without parents around, identified the soldiers by their national origin and such particulars as tattoos.

The report was sent up the UN chains of command in Bangui and on to Geneva and to New York, where officials apparently moved into high gear to address why Kompass sent the report to French officials. He had not told Navi Pillay, the high commissioner of human rights at the time, about the report. As one UN official said, if Pillay had known about it, “she could have cut through everything” and gotten to the heart of the matter.

When The Guardian broke the news in April 2015, relying on leaked documents from AIDS-Free World, the French government confirmed that it had already been investigating the allegations and that it had known about the report since July 2014. The French government announced in May this year that besides a police investigation, the justice department was taking on the case.

AIDS-Free World, the nonprofit group, is incorporated in New York; founded in 2007, it has evolved from focusing on eradicating AIDS to advocating more generally for human rights. Its co-directors are Stephen Lewis, a former envoy for the UN on HIV/AIDS, a deputy executive director for Unicef and Canada’s ambassador to the UN; and Paula Donovan, a former senior adviser on HIV/AIDS for the UN in Africa and an executive at Unicef. Donovan will not disclose who leaked the UN documents to AIDS-Free World, except to say that it was not Kompass.

Zeid Ra’ad al-Hussein, the UN’s current high commissioner for human rights, recently announced he was sending a team from Geneva to the Central African Republic to find more ways to address human-rights violations. He started as high commissioner in September 2014, and about a month later, he learned of the sex-abuse report.

A spreadsheet created by AIDS-Free World, located on its website, summarizes information drawn from the report submitted by the UN staff members who interviewed the boys in Bangui. The spreadsheet records dates of interviews, whether the victims were interviewed directly, their ages, details of the abuse (oral sex, sodomy, paid to find a sex worker are some of the categories), “country of perpetrator,” identifying marks and more information.

As part of UN protocol, it has invoked immunity for the human-rights staff member who did the investigation, keeping the French at arm’s length, France contends, thus stymying its own investigation, although it has had nearly a year to follow up on the case.

One journalist who asked not to be identified and who recently spoke to French investigators about the case was told that they have questioned the peacekeepers who had been at M’poko, but that they had not admitted anything.

The UN human-rights officer who questioned the boys had a background in child protection, but took a Unicef staff member with her to help ensure “she undertook the very delicate questioning of children on this issue,” a UN official informed of the case said in an email. Unicef “then immediately took on psychosocial and other discreet follow up (all very difficult with street kids in dangerous camps in a war zone, protected from people wishing to kill them by peacekeepers who were abusing them).”

Given the circumstances, the UN official noted in the email, the human-rights officer “did a marvellous job: thorough, brave.” She was “very sensitive to the kids.” In her statement (posted on AIDS-Free World’s website), she said that “no pressure was exercised on the children.” And that most of the children had trouble putting precise dates on the events “due to their young age.”

Some Western media have arrived in Bangui recently to try to interview the boys named in the report, leaving them more open to danger in a society “where everyone will know what the foreigners with cameras are doing in the camp, and where homosexuality may get you killed (even when you are a child victim),” the UN official said.

Zeid, the high commissioner, said at a press briefing in May about the boys’ vulnerability: “Yes, this report is now circulating among NGOs and the media. A French television station had no problem locating at least one of the children. But when the mother learned that her son had been involved in a sexual act with a man she became furious. She said that ‘if nobody had stopped me I would had killed him.’ ”

Almost a year later, the French have said little about the case. A spokeswoman for the French defense ministry told PassBlue in a Skype call that the office “cannot express information about the investigation because the justice secretary/department is investigating it.”

The spokeswoman, who refused to be identified, said that asking the justice ministry for a comment would not result in a response. “That’s the way it is,” she said.

[This article was updated on June 9, 2015, to correct an original reference to “clinical reports submitted by the UN staff members who interviewed the boys in Bangui.” The “clinical reports” were actually a spreadsheet compiled by AIDS-Free World summarizing information drawn from the UN report of interviews with children and the alleged sex abuse by international soldiers.]

Peacekeepers from Ecuador, left, and Chile providing care at the Fraternite Notre Dam Medical Clinic, above the hills of Port-au-Prince, the capital of Haiti. LOGAN ABASSI/MINUSTAH

Almost five years after a rampaging cholera epidemic coursed through the Artibonite River region of Haiti and moved rapidly around the country, the United Nations, which acknowledges that a deadly strain of the disease originated in or around a Nepali peacekeepers’ base, is tightening medical prevention rules for soldiers and police.

National governments will now be responsible for ensuring that vaccinations or prophylactic drugs have been given to troops coming from (or going to) areas of endemic disease. If countries fail to abide by the rules and the UN must assume the task of providing preventive medication, troop-contributing countries will be billed for this service as a deduction from payment for peacekeeping work.

The decision to make vaccinations, including cholera as well as antimalarial medications and equipment like mosquito nets and bug sprays, mandatory for all deploying peacekeeping personnel was made in January 2015 by the UN departments of management and field support, based on the revised Contingent-Owned Equipment Manual, 2014 edition.

For the first time, the decision whether to vaccinate or to take other medical precautions is not being left to the troop contributors. The new policy was transmitted to the General Assembly for distribution early this year, and the Department of Field Support, part of the Department of Peacekeeping Operations, is working with troop-contributing governments to put the new procedures into practice, UN officials said.

The manual, which covers many areas of troop contributors’ logistical commitments, is clear on the vaccination policy:

“The administration of vaccinations, as recommended by the United Nations, is a national responsibility. The United Nations will provide necessary information on what kind of vaccination and preventive measures will be given to all United Nations personnel prior to deployment.

“If any United Nations personnel deploy without proper vaccinations and prophylaxes, the United Nations will provide necessary booster shots and prophylaxes. In this case, the United Nations will deduct any expenses for initial vaccinations, which could have been initiated prior to deployment from the self-sustainment payment of troop/police-contributors.”

UN officials have also clarified in interviews the system under which sanitation and other facilities are constructed in countries where UN troops and police are deployed. It has been customary to hire local contractors for numerous construction and maintenance jobs. In Haiti, the latrines found to be faulty on the Nepali battalion’s base, allowing raw sewage to seep into natural waterways, were built by Haitian contractors, not by UN employees, officials said.

Agreements between the UN and countries contributing troops and police officers to missions are concluded in memoranda of understanding that can take a relatively long time, often months, to finalize. There are cases where the troops arrive at a duty station before a formal agreement has been signed. In the past — apart from bringing endemic illnesses that may not have been detected because of lack of symptoms — troops from some countries have arrived without proper equipment or clothing for the task or location to which they are assigned.

The revised manual and its predecessors attempt to set out in writing exactly what is expected of troop contributors, who are paid through assessments of UN member nations.

On medical issues, decisions by governments have been mixed. In October 2014, Sierra Leone quarantined an 800-member battalion of peacekeepers preparing to be sent to Somalia to join an African Union mission after one soldier tested positive for Ebola. The soldier had gone AWOL from a military camp, apparently to return to his village for a visit, during which he was infected. All 800 troops were confined in isolation for 21 days, the Reuters news agency reported.

The behavior of the Nepali government and military was very different, although cholera is endemic to Nepal (and India) and there had been recent cases in the region. Haiti’s consequent cholera epidemic became a sharp lesson for the UN in what happens when anything about peacekeeping is left to chance.

To mark International Women’s Day in 2015, the UN Women entity organized a street rally to take place in Midtown Manhattan on March 8. J. CARRIER/UN WOMEN

The 2010 creation of the United Nations Entity for Gender Equality and Women’s Empowerment (or UN Women) represented an unusual organizational consolidation instead of the typical proliferation. It had a promising start under strong leadership but faces serious challenges with growing resistance to gender equality.

Support for women’s rights has a long and checkered history in the UN. One of the earliest intergovernmental commissions was the Commission on the Status of Women (CSW), which first met in 1947, but from its inception the UN system lacked strong institutional arrangements to provide intellectual leadership about gender equality; to support governments to translate commitments into action; and to help translate women’s aspirations into reality.

A longstanding demand of the women’s movement had been the creation of a single UN institution that could spearhead change. The 2010 General Assembly resolution, 64/289, created UN Women and was a symbolically important bridge between rhetoric and action; it was a welcome consolidation almost unprecedented in the UN’s life. The four component parts were the United Nations Fund for Women (Unifem); the Institute for Training and Research on Women (Instraw); the Division for Advancement of Women (DAW); and the Office of the Special Adviser on Women (Osagi).

To continue reading this briefing, published by the Future United Nations Development System (FUNDS), a project of the Ralph Bunche Institute for International Studies, click here.

The aftermath of a barrel bomb dropped by Assad’s government. Syrians are leaving what is left of their country in droves as refugees in neighboring nations abscond for Europe too. FREEDOM HOUSE

As a relentless remake of the Middle East and North Africa has been taking place, mass displacements of populations have also been occurring. And more chaos is ahead, says the United States Defense Intelligence chief, Lt. Gen. Vincent Stewart, in his assessment that Iraq and Syria may have been permanently torn asunder by war and sectarian tensions.

In the past weeks media screens have been filled with images of parents treading water to keep their children’s head above the waves, a toddler’s body washed ashore with his shoes still on, columns of refugees walking across whole countries to get to safety, the return of barbed-wire borders and numbers stamped on people. While this recent surge of people from the Syrian conflict into Europe has been widely reported, the reasons for the influx have not received as much focus. Many refugees, for example, are streaming from older conflicts, such as in Afghanistan, where instability prevails.

Of the 11 million people displaced from the Syrian conflict alone, the United Nations refugee agency counts four million registered refugees, mostly located in Turkey, Lebanon and Jordan. Turkey has the largest number, with more than two million Syrians and Iraqis, having kept an “open door” policy.

Even Turkey, which has a developed economy, is stretched, having spent more than $6 billion so far, with only $417 million in aid. Mevlut Cavesoglu, the foreign minister, told PassBlue that “this burden must be shared. But not only by Turkey or the neighboring countries but also by other developed countries.”

Turkey provides education in Turkish and Arabic in the refugee camps, among other services. But not all refugees are living in camps or are registered with the UN. “An estimated 400,000 children cannot avail this education as they don’t live in the camps but in other cities. . . . We’re losing a generation here,” Cavesoglu added.

Lebanon, with its small, ethnically divided population and weak economy, is even more overwhelmed. Hala Helou, a senior adviser for the social affairs minister, said in an interview that two million people, almost 30 percent of Lebanon’s population, are refugees; or 25 percent, if one counts only those registered with the UN refugee agency. Of these, 18.4 percent are living in camps.

“We cannot respond to that on our own, or even survive that,” Helou said. A UN multiagency appeal of $2.1 billion for Lebanon is only 60 percent funded, with money coming from the European Union and the United States Agency for International Development, or USAID.

“The government is working on a Lebanon Crisis Response Plan for a more integrated response, shifting from humanitarian short-term to development long-term provision of services, for which we have started to receive some funding from Kuwait.”

Conditions inside Syria for everyday citizens have become far more unbearable, with escalating attacks by the government through barrel bombs and young men being forced into military conscription, causing hordes of people to abscond. The latest report by the UN’s Commission of Inquiry on Syria once again described the bombardments as war crimes, saying the “transgressions are massive in extent and scope.”

Violence inflicted by ISIS and other government opponents is also abetting the surge as Syrians desperate to stay alive are packing up their few belongings, with children and infants in tow, to cross the “blue borders” of the Mediterranean and the Aegean seas, as the International Organization of Migration calls the passage.

Almost 475,000 people have made the sea trek this year so far. In an interview, Ashraf El-Nour, the organization’s representative to the UN, called the Mediterranean “the most active, dangerous, dynamic border, with not just one front [but] at least three fronts.”

Another trigger to the boatloads of Middle Eastern refugees crossing from Turkey to Greece this summer, taking advantage of the warm weather, has been the drastic drop in UN agencies’ provisions of food and medical aid because of cuts in UNHCR funding, the UN has been saying. As António Guterres, the UN high commissioner for refugees, bluntly warned in July, the agency was “financially broke.”

The UN has received just $1.67 billion of the $4.5 billion it needs this year to manage the Syrian refugee crisis. (Guterres recently announced that he was stepping down from his post by the end of the year. The UN has been silent about who is replacing him.)

The World Food Program had to cut rations for 1.6 million Syrians, with refugees in Lebanon allocated just $13.50 a month in July 2015. In Jordan, 229,000 refugees stopped receiving any food aid.

Mirsada Colakovic, until recently the UN ambassador of Bosnia-Herzegovina, was once a refugee. “My mother was a lawyer; when I told her on arrival in Belgium, after a year in Croatia as refugees, ‘Mama, we got the numbers [that recognize we are refugees],’ she cried. ‘Do you know what that means? It means we are homeless, we have to try survive in another way,’ ” Colakovic recalled by phone from Sarajevo.

“As a refugee, you do any job, because you have no working permission. . . . Decades later, when I went to visit camps in Jordan as a deputy ambassador, the people were asking to work. When you are working, you have value as a person.”

When senior politicians from around the world met at the UN for the Inter-Parliamentary Union speakers’ conference earlier in September, the parliamentary declaration boldly highlighted the migration/refugee challenge as the European Union prevaricated on the issue. The organization’s annual General Assembly in Geneva later this year will focus on it as well.

“Migration, whether forced or voluntary, is a fixture of today’s world,” the declaration read. “People can and will move to other places in search of a better life. . . . We call on all States to protect refugees, internally displaced persons and migrants and to help build stable and prosperous societies in their countries of origin.”

Refugee experts have warned against interchanging the use of the terms migrant and refugee. “Forcibly displaced people is being used as broader term for refugees, but it’s a mischaracterization,” said Arianne Rummery, a senior communications officer for the UN High Commissioner for Refugees. “Calling it a migrant crisis downplays obligations under the 1951 Refugee Convention. We don’t think it’s the right word to characterize movement of Syrians, Iraqis.”

Yet certain situations that fall outside strict definitions need protection too, said Bill Frelick, the director of the Refugee Rights Program at Human Rights Watch, in an e-mail exchange from Skopje, Macedonia.

“Because the Refugee Convention definition also requires alienage to qualify, internally displaced people are not encompassed in that definition, but would nevertheless be forced migrants, and should be recognized for their vulnerability.”

El-Nour of the International Organization of Migration urges longer-term solutions to the problem of categorization and processing, such as a common approach involving destination, transit and source countries. “We welcome the inclusion of well-managed migration policies in the 2030 targets, goals,” he said, referring to the new Sustainable Development Goals.

The UN’s envoy on migration, Peter Sutherland, goes further in a recent media interview, saying: “The desperate plight of many economic migrants escaping from dire poverty should drive us to seek to open up new avenues for legal migration.”

The European Union has a Common European Asylum System, but at its Sept. 14 meeting, its Justice and Home Affairs Council was unable to agree on numbers beyond the 40,000 agreed on under the voluntary distribution scheme. Only Germany has resolved to take substantial numbers, up to 800,000 this year, which its administrative systems are struggling to process.

The Council did agree to increase European funding for the UN refugee agency and the European Union’s regional Madad Fund for Syria and its immediate neighbors.

So where is the UN Security Council amid the rising tide of misery, which by now could be interpreted as meriting the Council’s threshold of being a threat to international peace and security?

Dina Kawar, the ambassador of Jordan to the UN, the only Arab country on the Security Council as an elected member, said in an interview: “We have co-sponsored three resolutions on the humanitarian crisis in Syria; Jordan is also hosting 1.4 million Syrian refugees.” However, Kawar acknowledged that a comprehensive Council plan on how to end the Syrian conflict and how to protect the displaced population has not happened.

With the UN working with its third special envoy for Syria to end a three-pronged war — Assad vs. rebels vs. ISIS — the Council is divided between those who favor Assad’s government as part of a solution and those who are determined that Assad must go. The only common point is that ISIS has mutated into a monster that must be destroyed. President Putin of Russia, who is heading to the UN on Sept. 28, said he had a plan to resolve the Syria catastrophe and will discuss it with President Obama, who is also scheduled to speak at the UN the same day.

But as Stewart Patrick of the Council on Foreign Relations said recently, a Security Council resolution on protecting and resettling refugees is “highly unlikely” in this situation.

The world faces a shortage of midwives, who could cut maternal death rates, especially in poor countries, if trained and employed. Here, Cambodians training to be midwives in an Australian-financed program at the Technical School for Medical Care in Phnom Penh. CHRISTOFFE GARGIULO

Midwifery is one of the world’s most ancient vocations, its practitioners playing a prominent role dating back to the Bible. In much of the world, midwives continue to play an important role in maintaining the health of women and newborns.

It should come as no surprise, then, that investments in this occupation, according to the United Nations Population Fund (UNFPA), could help avert two-thirds of global maternal and newborn deaths. UNFPA, the lead UN agency working to enhance the midwifery profession, has achieved a great deal of progress in this area, helping to train more than 60,000 midwives since 2009 and supporting more than 65 countries in strengthening their midwifery workforce policies through the Maternal Health Thematic Fund, the agency’s program for improving maternal and newborn health. Much of its money comes from foreign governments and private-sector and civil society organizations.

The UN Population Fund spent more than $120 million in 2014 on maternal health services alone. Yet while it employs maternal health specialists, it does not even have a midwife on staff at its New York headquarters, conveying a subtle message, one outside expert said, that the agency is not focused enough on the profession.

Moreover, increasing the number of midwives worldwide, especially in poor countries with minimal health care systems, where midwives can make a huge difference, remains a serious problem. For starters, governments are not prioritizing the professionalization of midwifery.

As outlined in the 2014 State of the World’s Midwifery report published by the UN Population Fund, only 22 percent of countries globally have enough educated midwives to meet the basic needs of women and newborns; and 78 percent of the countries are facing serious shortages in midwifery, which will result in unnecessary deaths of women and babies.

And while the maternal mortality rate has fallen 44 percent globally since 1990, according to a November report by UN agencies and the World Bank, published in The Lancet medical journal, only nine countries achieved the UN Millennium Development Goals target of reducing the maternal death ratio by at least 75 percent between 1990 and 2015.

That would also mean that the UN’s new global goals — which begin in January and include cutting maternal deaths to fewer than 70 per 100,000 live births globally by 2030 — will require more than tripling the pace of progress, from the 2.3 percent annual improvement in maternal death ratio recorded between 1990 and 2015 to 7.5 percent a year beginning in 2016, according to a recent joint statement from the UN Population Fund, Unicef, the World Health Organization and the World Bank.

“Many countries with high maternal death rates will make little progress, or will even fall behind, over the next 15 years if we don’t improve the current number of available midwives and other health workers with midwifery skills,” said Dr. Babatunde Osotimehin, the executive director of the UN Population Fund and a Nigerian, in the statement. “If we don’t make a big push now, in 2030 we’ll be faced, once again, with a missed target for reducing maternal deaths.”

Frances Ganges of the International Confederation of Midwives.

Some maternal health advocates fault governments for the inadequate number of midwives, who in addition to delivering babies, serve other vital roles such as introducing the subject of contraceptives for women whose health is impaired by too many pregnancies, discussing breast-feeding and nutrition for mothers and their babies and participating in campaigns against procedures such as female genital mutilation.

“Governments aren’t putting money where their mouth is,” said Frances Ganges, chief executive of the International Confederation of Midwives (ICM), an association that seeks to strengthen the profession globally. Noting that it is estimated that the world needs at least 350,000 midwives to meet the health care needs of women and newborns, Ganges said that in some places, midwives make less than $200 a month even after completing five years of education. If maternal health is to be a priority, she said, no one can work “for less than living wage,” including in poor countries.

Dorothy Lazaro, a UN Population Fund midwifery specialist and adviser based in Ethiopia, said that midwives, who focus their care on mothers and babies, are important in managing maternal complications such as hemorrhages and convulsions, skills that many nurses or community health workers in developing countries are not trained to handle.

Referring to the collaboration between the UNFPA and the International Confederation of Midwives through the Maternal Health Thematic Fund (with additional money contributed by foreign governments), Lazaro said that in Ethiopia, for example, only 1,275 midwives served a population of 90 million people in 2009.

The UN and the midwife confederation worked with the Ethiopian government to train 4,470 midwives and started programs in 48 training institutions, including a master’s degree program, aligned with the confederation’s curriculum standards. “So many countries that have been working with UNFPA have done exactly that,” Lazaro said.

Dr. Michel Brun, a maternal health adviser at the UN Population Fund, also noted the partnership with the ICM in carrying out training programs and setting professional standards. While the number of midwives on the ground may have increased, “the focus is on quality of care,” he said.

Lazaro of UNFPA agreed that a big concern is the lack of practical skills. Midwives “need hands-on skills . . . to save the life of the mother and baby.” Mentoring is key; often midwives are sent to health clinics without supervision. In Ethiopia, a mentoring program was established in which senior midwives support new ones for a three-week period, followed by continued support afterward.

Lazaro stressed the importance of continuing education for midwives, as “there’s always new information coming.” Many midwives also work in rural areas. “They really need to have that network,” she said.

The placement of midwives is also critical to delivering the best health care.

“Once you have your midwives well trained, then you have to deploy them in the different levels of the health system,” Dr. Brun said. For example, in a Basic EmONC (Emergency Obstetric and Neonatal Care) facility, midwives can handle rudimentary complications that can arise during childbirth without needing an obstetrician-gynecologist, he said.

“The midwives can be deployed much closer to the population” at such a facility, engaging in regular contact with community leaders and health care workers to increase awareness of pre- and post-natal complications. “This is the challenge,” he said.

Monitoring how midwives are doing is also important, Dr. Brun said. The UN Population Fund set up a system to collect and analyze data, including tracking every maternal and newborn death. “The goal is to understand what happened,” he said, to learn from their failures. On the flip side, it is also vital to note good practices on the ground in specific countries, to have the “opportunity to learn from what they are doing.”

Midwives in the field largely appear satisfied with the UN’s commitment to midwifery. “They are doing a fantastic job,” Lazaro said, noting how the UN Population Fund, which focuses on resources and training for midwives, complements the work of the larger H4+ collaboration (World Health Organization, Unaids, UNFPA, UN Women, Unicef and World Bank), which oversees policy issues and standards of competency.

Indigenous midwives in Chiapas, Mexico. Besides delivering babies, midwives can provide such services to mothers as breast-feeding instruction and contraceptive information. PWRDF

“Both in principal and in practice, there has been a show of commitment” by UNFPA “to midwifery as a profession,” said Ganges of the International Confederation of Midwives, based in The Hague. “They have been very supportive.”

“UNFPA has been our biggest partner in the UN agencies,” Ganges added, noting its key role in the five-year Maternal Health Thematic Fund project and its discussions with the International Confederation of Midwives on strengthening midwifery in the 22 countries of Francophone Africa, an initiative that she hopes will run through 2017. (Here is a video, in French, on midwifery in those nations.)

The countries are Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Ivory Coast, Democratic Republic of the Congo, Djibouti, Gabon, Guinea, Madagascar, Mali, Mauritania, Morocco, Niger, Republic of Congo, Senegal, Seychelles, Togo and Tunisia.

Ganges said that Chad, Central African Republic and Burundi are among the 10 countries with the worst maternal mortality rates globally; they are also among the world’s poorest nations.

She said that the UN Population Fund also agreed this year to finance an International Confederation of Midwives study in Kenya to perform a gap analysis in midwifery education and regulation, and has financed forums on midwifery issues.

Ganges remains discouraged, however, that there is no actual midwife on staff at UNFPA headquarters in New York. “I think it should be a priority, and it doesn’t seem to be,” she said. “I think it sends a double message.”

While efforts have been underway to recruit a midwife in New York, Ganges — who told PassBlue she has offered to help with the interview process — has not seen any public announcement or bulletin. “The answer is vague or ‘I don’t know,’ ” she said. “It’s very, very disappointing.”

Lothar Mikulla, a UNFPA spokesperson, told PassBlue recently that “the recruitment process is still pending.”

Much of the agency’s financing comes from well-off European countries such as Norway. Last year, Norway contributed about $94 million, according to Fredrik Arthur, the senior adviser and ambassador for women’s rights and gender equality at the Norwegian Foreign Ministry. This “reflects overall confidence in the UNFPA mandate” and its “practical work on the ground,” he said.

How does Norway monitor the UN Population Fund’s use of funds? The country participates in board meetings three times a year and is part of the Multilateral Organisation Performance Assessment Network, a nonprofit group that monitors institutions such as the UN and its agencies. According to the network’s 2014 annual report, “UNFPA has over the last few years taken a number of initiatives aimed at strengthening the organisation’s mandate and its focus on results, and to improve accountability.”

While Arthur acknowledged that the Foreign Ministry relies on reports from such nonprofit group networks, and not firsthand accounts, UNFPA “has been given green lights,” Arthur said. “We’re satisfied.”

A class of graduated midwives in South Sudan.

The UN Population Fund is not the only UN agency promoting midwifery. Unicef spent close to $145 million on maternal and newborn health programs in 2014. It distributes midwifery kits, for one, containing basic drugs, renewable medical supplies, medical equipment and basic sterilization and resuscitation equipment for health facilities to perform an average of 50 normal deliveries.

Kim Dickson, Unicef’s senior adviser on maternal and newborn health, noted in an e-mail interview that the organization worked closely with UNFPA, “according to modalities agreed upon” in the countries where they both operate.

“In Sierra Leone and Sudan, for example, UNICEF helped train midwives on how to provide support to women who are victims of female genital mutilation,” Dickson wrote. “In Indonesia, we partnered with a mobile network to broadcast educational and technical updates to midwives across the country and link village midwives with their pregnant clients.”

Acknowledging the challenges midwives face, Dickson noted that “too many countries place restrictions on what midwives can and cannot do, even within their professional domain, often with tragic consequences.”

Where there are not enough doctors available, midwives need to be allowed to perform such services as giving injections, manually removing the placenta, administering newborn resuscitation and administering antibiotics in case of infection, Dickson said. “Such interventions can help avoid further tragic deaths among mothers and newborn babies.”

Dr. Doris Chou, a co-author of the recent maternal mortality study published in The Lancet and a medical officer in the Department of Reproductive Health and Research at the World Health Organization, was optimistic about the findings.

“While the estimated decline in maternal mortality did not reach the MDG target, it remains a significant decline, and one that may not have happened if the Member States of the UN did not agree to the MDGs in 2000,” Dr. Chou wrote in an e-mail. “In other words, countries became interested in progress when it was agreed that progress would be monitored.” She agreed, however, that better data on the ground must be collected.

Indeed, is the new goal of fewer than 70 deaths per 100,000 births by 2030 realistic?

“Certainly, it is ambitious,” Dr. Chou said. “But if there is will, and a collective global commitment, yes — it is.”

At a UN event on post-rape care, a young Malawian told her story of being raped as an 11-year-old. Here, she is embraced by Patricia Kaliati, a Malawi government official. TOGETHER FOR GIRLS

Maureen Phiri, a young girl from a poor family in Malawi, was only 11 years old when she was raped by the man who had hired her to do housework for him and his wife. Not only did Maureen continue to experience sexual abuse from the man she worked for, he left her with another long-term scar: HIV-positive status.

Had Maureen or her family known that it was possible to prevent HIV infection merely by seeking medical care within 72 hours post-rape, her story — told by Maureen, who is now 20, to an audience at the United Nations recently — might have taken a different turn.

Recognizing the plight of girls and women like Maureen around the world, a coalition of organizations is aiming to mitigate the post-rape trauma they endure through a new campaign, #EveryHourMatters (everyhourmatters.org), to promote emergency medical care within 72 hours of rape to prevent HIV/AIDS and within 120 hours for preventing pregnancy. The campaign reflects a concerted effort to get more people involved on the communal, national and international level to focus on post-rape care action.

The campaign is sponsored by Together for Girls, a public-private group in Washington, D.C., in cooperation with the World Health Organization, UNAIDS, UN Women, Unicef, UN Population Fund, various governments and other private and public entities. The campaign introduced its message at the UN’s 60th Commission on the Status of Women this month at a panel event on post-rape care, held at UN headquarters.

“We know the stats about sexual violence against girls,” said Catherine Russell, the United States ambassador at large for global women’s issues, speaking at the event. Roughly 20 percent of girls’ first sexual encounter is actually rape. “Very few of those rapes are reported.”

Noting that adolescent girls already face unique personal and social challenges, it is important to recognize that what happens to a girl from 12 to 14 years old does “not occur in a vacuum,” but serves as a foundation for their lives, Russell said.

Michele Moloney-Kitts, executive director of Together for Girls, bemoaned the topic itself, saying, “We wish we weren’t highlighting the timeliness of post-rape care,” when rape prevention is the most important issue. But “time is of the essence” in handling the immediate aftermath of such an assault.

As Gary Cohen, the founder of Together for Girls, pointed out: “The first reproductive right is the right not to be raped. No matter how long this takes us, we have to work with unstoppable resolve to stop this issue.”

One in five girls has experienced sexual violence before age 18 (versus one in seven boys), noted Patricia Kaliati, the minister of gender, children, disability and social welfare for Malawi. She cited her country’s work to help rape victims, such as providing one-stop centers with comprehensive post-rape care, including counseling and prophylaxis medication to prevent HIV infection.

Yet stigma remains a large barrier to administering post-rape care. When Malayah Harper, the chief of gender equality and diversity at UNAIDS, lived in Kenya, she had a gardener who tended her residence through a contractor. After the gardener’s daughter was raped by several perpetrators, in a different part of the country, he took a week off from work to help her; she had dropped out of school, received no health care and was afraid to run into her rapists, who lived nearby.

While the daughter received post-rape care and counseling, she was unable to obtain justice against her attackers, and the father’s employer fired him for taking time off to assist his daughter.

“This is kind of a social norm” for the treatment the gardener received, Harper said. The story gets to “the heart of how we value women in society.”

Unfortunately, women and children and survivors of rape in general usually don’t know about the short window of time — 72 to 120 hours after a sexual attack — to seek important emergency care, said Dr. Claudia Garcia-Moreno, team leader of the violence against women sector in the World Health Organization.

The WHO therefore helped develop clinical handbooks for post-rape care and published, along with the UN Office on Drugs and Crime and UN Action Against Sexual Violence in Conflict, a manual, “Strengthening the Medico-Legal Response to Sexual Violence,” last November, detailing the steps that need to be taken by medical and legal authorities after reporting a rape. “This is a very simple attempt to work together with stakeholders,” Dr. Garcia-Moreno said.

As for Maureen Phiri, the Malawian who bravely talked about her rape, she eventually became involved with Plan International, the child development organization, through its office in Malawi, and later had the opportunity to speak before the media. “I came to understand that what this man was doing to me was wrong.”

“I’m not ashamed of it,” said Maureen, who is receiving HIV treatment, her voice choked with emotion as participants at the UN event also appeared visibly moved. “It is important that we provide more information that post-rape care is there and to prevent HIV, at every corner, at every health facility in every community, to prevent HIV in that window period after rape.”

Now that #EveryHourMatters has begun to be carried out online, “the reaction to the campaign has been very positive, especially on social media, where we have seen a great deal of sharing of the campaign messaging and graphics by our partners and the general public,” said Sandie Taylor, the director of communications and operations for Together for Girls, in an e-mail after the event.

Several more programs on Every Hour Matters, Taylor said, will be held this year, including at the Women Deliver conference scheduled to take place in Copenhagen in May.

In the Madhya Pradesh region of India, specialists teach breast-feeding to mothers in nutrition-rehabilitation clinics, with money from the British development agency. RUSSELL WATKINS/DIFD

Although more countries have been passing laws to promote and to protect breast-feeding, the breast-milk substitutes industry continues to present a formidable challenge to achieving universal breast-feeding goals, a new report by United Nations agencies and a large advocacy group reveals.

The laggards? Some of the richest regions in the world. Europe, for example, remains at the bottom of legislating laws to promote and protect breast-feeding.

Paradoxically, research published this year in the medical journal The Lancet shows that breast-feeding is one of the few positive “health behaviors” that is more prevalent in poor countries than in wealthy ones.

Of the 194 countries analyzed in the May 2016 report from the UN and the International Baby Food Action Network (IBFAN), a sprawling advocacy group that strives to reduce infant and child deaths worldwide, 135 countries have set up some form of legal measures related to the International Code of Marketing of Breast-Milk Substitutes.

The code was adopted in 1981 by the World Health Assembly, the governing body of the World Health Organization, and augmented with later resolutions tied to the code’s mandate. It aims to support breast-feeding while also ensuring the “proper use” of breast-milk substitutes and the “appropriate marketing and distribution” of them worldwide.

The infant formula industry has fought the code with remarkable power, advocates say, as a new generation of sweetened milks for children begins to saturate the market with dubious health claims, through blessings from such countries as the United States and New Zealand, advocates also warn.

The rate of compliance by nations to abide by the international code has increased 88 percent since 2011, when the World Health Organization last analyzed this topic. The 2016 report notes, however, that the increase partly reflects that more information has become available on adherence to the code since before 2011.

Only 39 countries have laws enacting all provisions of the code, a mere five percent increase from 2011. A broad range of 49 countries has no legal measures in place, including the United States, Australia, Belarus, Haiti and elsewhere in the Caribbean, Bhutan, Japan, New Zealand, Chad and other nations in Africa.

Full provision of the code is enacted in an equally disparate group of nations, such as Afghanistan, Bahrain, Brazil, Cameroon, Costa Rica, India, Kenya, Lebanon, Nepal and, recently, in Vietnam.

Patti Rundall, the policy director of Baby Milk Action (part of IBFAN), singled out India, the second-most populous country in the world, for its strong legislation to conform to the code and for pushing back against the infant formula industry.

Although no single reason explains why certain countries have passed laws or measures to conform to the code and others have not, some countries provide a “friendly atmosphere” to the lobbying industry of infant formula makers, said Laurence Grummer-Strawn, who was involved in the report as a technical officer in the Nutrition for Health and Development sector of the World Health Organization in Geneva.

Certain countries, Grummer-Strawn added, may be more open to the arguments of the breast-milk substitutes industry, which is dominated by such multinational corporations as Nestlé and Danone, so these countries have weaker laws or none at all regarding the marketing of infant formula.

Moreover, a sense that breast-feeding in rich countries is not important may be related to people thinking that if they have access to clean water (in which to mix the formula), using it is a fine alternative, Grummer-Strawn noted.

The report, titled “Implementing the International Code of Breast-Milk Substitutes in Countries: Time to Accelerate Action,” featured the rare participation of the World Health Organization and Unicef with an advocacy group, IBFAN, Rundall said in a conversation from her base in Cambridge, England. (IBFAN, founded in 1979, was a main campaigner behind the code’s realization.)

“It’s the first time such a report was done with all three,” she said. “Why didn’t we do this before? We come at it from slightly different places, so the report is a compromise, a struggle to get it, but it’s fine, it’s O.K.”

The region with the highest rates of enacting full legislation is Southeast Asia, at 36 percent; followed by Africa at 30 percent; and eastern Mediterranean, 29 percent.

The Americas (including the US) had 23 percent, or 8 out of 35 countries; Western Pacific region, 15 percent; and Europe, six percent.

Most national data that were used for the report were submitted through questionnaires, with information gaps filled by experts. No data was available from 10 nations, including in Africa, Europe and the Western Pacific region.

Both the World Health Organization (WHO), a staunch supporter of breast-feeding, and Unicef recommend that babies be fed breast milk exclusively for the first six months of their lives, after which they should continue breast-feeding — as well as eating other “safe and nutritionally adequate foods,” the report said — until two years old or beyond.

WHO member states have made commitments to increase the rate of exclusive breast-feeding in the first six months of life to at least 50 percent by 2025, among other global nutritional goals.

Breast milk is considered safe and clean and contains antibodies that help protect infants against many common childhood illnesses, research shows. Breast-fed children perform better on intelligence tests, by about three IQ points, Grummer-Strawn said, and they are less likely to be overweight or obese and less prone to diabetes later in life.

The act of breast-feeding itself stimulates proper growth of the mouth and jaw and secretion of hormones for digestion and satisfied bellies. Women who breast-feed have a lower risk of breast and ovarian cancers.

Only one Sustainable Development Goal focuses strictly on nutrition. Goal 2 aims to end all forms of malnutrition, including addressing the nutritional needs of lactating women and others.

Near-universal levels of breast-feeding, The Lancet reported earlier this year, could save 823,000 annual deaths for children under five years old. Globally, nearly two out of three infants under six months old are not exclusively breast-fed — a rate that has not improved in two decades.

Fewer than one in five infants is breast-fed for 12 months in high-income countries, and only two out of three children between 6 months and 2 years old receive any breast milk in low- and middle-income countries.

Achieving universal breast-feeding faces a formidable foe in the breast-milk substitutes industry, advocates say. Here, a preemie breast-feeding. CREATIVE COMMONS

The goal to reach universal breast-feeding contends with a well-financed foe: the breast-milk substitutes industry, which has annual sales totaling nearly $45 billion worldwide, the WHO says. The industry is projected to grow to $70 billion by 2019, with new products like sweetened milk for children flooding the market.

These projections are based on many factors, Grummer-Strawn said, including how fast countries are growing economically as well as national politics. Heavily populated China, for example, is considered a huge emerging market for consumer products, while reports of unscrupulous marketing tactics by outside salespeople of infant formula in China have been exposed.

Aggressive marketing of breast-milk substitutes — infant formula, feeding bottles, pacifiers and other items — continues to undermine work to improve breast-feeding rates, say specialists at the UN and at IBFAN.

Globally, the prevalence of breast-feeding at 12 months is highest in sub-Saharan Africa, South Asia and parts of Latin America, according to The Lancet. In most rich countries, the prevalence is lower than 20 percent, with stark differences found even among those nations — like between Britain (less than 1 percent) and the US (27 percent); and Norway (35 percent) and Sweden (16 percent).

Promotion of breast-milk substitutes is shifting from advertising in stores and mass media to the Internet and social media, raising legal and practical challenges, The Lancet said, requiring countries to better manage the newest sales methods of reaching consumers.

The UN report stressed the importance of monitoring the International Code of Marketing of Breast-Milk Substitutes through a mechanism to detect violations and report them to authorities. But political engagement is almost nil: only 32 countries have such a mechanism, with few fully functional.

The use of infant formula in poorer countries can be problematic because of lack of clean water and sanitizing equipment to prepare the formula for feeding. In addition, social and commercial pressures worldwide to stop breast-feeding, Unicef says, contributes to its stall in becoming universal.

These pressures combine with faulty or inadequate information in health care centers, such as hospitals, where support for new mothers to breast-feed can be minimal or conflicting. (In New York, for example, this writer, preparing to leave the hospital soon after giving birth in 1988, was handed several cans of free infant formula by a nurse, despite actively breast-feeding.)

Complicating matters, Unicef says that many women must return to work soon after they give birth, leaving them with tough choices as to whether to keep breast-feeding exclusively. Grummer-Strawn said working women throughout the world face barriers to breast-feeding, not just in well-off countries. The goal, he said, is to better enable breast-feeding in all work settings.

Infant formula was highlighted by many international media when a long-awaited UN-led convoy of aid destined for Syrians in Daraya, a besieged area outside Damascus, was blocked on May 12 by soldiers in the 4th division of the Syrian Army, which is controlled by Maher al-Assad, the brother of Bashar al-Assad, the country’s president.

Which leads to the question why infant formula was being donated to residents of an area that reportedly has no running water or other appropriate sanitary conditions in which to prepare the baby food. Standards by WHO and Unicef on managing the use of infant formula in humanitarian emergencies have been outlined in policies, including banning free donations of such supplies.

Linda Tom, a spokeswoman for the UN Office for the Coordination of Humanitarian Affairs in Syria referred questions to the Syrian Arab Red Crescent, or SARC, as to why infant formula was part of the UN convoy to Daraya.

“You are correct in that the UN does not usually delivery infant formula,” Tom wrote in an email. “On the rationale, you will need to address your question to SARC.” That group did not answer emails from this reporter.

Breast-milk substitutes should be used only as a last resort, two UN experts recently wrote in an essay but common misconceptions persist, they said, including that mothers who may be malnourished or who live in stressful situations cannot breast-feed.

Grummer-Strawn of WHO said that aid provisions of infant formula to emergency situations are done on a case-by-case basis, and though potable water may not be available to mix infant formula powder, water can be boiled for ingestion. Up to five percent of women in emergency settings cannot breast-feed for various reasons, such as illness or being separated from their infants, he added.

Rundall noted that WHO and UNICEF policy states that donations of breast-milk substitutes, bottles, teats and other milk products in emergencies should be avoided, but she added that a fairly high percentage of bottle feeding exists in Syria, “so all this must be handled sensitively.”

“If formulas are needed — and of course they sometimes are — they should be purchased, distributed and used according to strict criteria by those who really need them. Well-meaning people are often unaware that these products can do more harm than good. What’s needed are health workers who are well trained in providing breast-feeding support.”

The global controversy over infant formula use originated with a boycott carried out in the US in 1977 against the Swiss-based Nestlé company, prompted by concern over its aggressive marketing tactics of breast-milk substitutes, particularly in poor countries, and the possibility of fostering malnutrition.

The boycott spread to Europe in the early 1980s, with actions still underway in Britain through Baby Milk Action, Rundall’s organization. The 1977 boycott led to the creation of the International Code of Marketing of Breast-Milk Substitutes.

The controversy continues, as a statement from Baby Milk Action, IBFAN and others remarked on a recent World Health Assembly meeting regarding “two closely linked hot topics: how WHO should interact with businesses and venture philanthropies and whether trade should come before health when tackling the marketing of baby foods and formulas.”

The statement said: “During a full week of behind-closed-doors negotiations on both topics, the United States and rich producer countries in the EU and New Zealand, pushed the interests of their corporations: opposing the adoption of effective safeguards to protect WHO’s independence, integrity and credibility and attempting to sabotage the adoption of a new WHO Guidance on baby foods. The bullying power of these nations and their disregard of public health was evident in the two Resolutions that were finally adopted today.”

The resolution on infant and young-child feeding focused, for example, on a “new generation of processed, expensive, sweetened and flavored milks that are fuelling the obesity epidemic and causing great concern,” the statement said.

These products are not infant formula, so they can be exempt from laws regulating the marketing of such goods, although they resemble infant formula packaging and are targeted for infants and children, Grummer-Strawn said.

Rundall said that the US, backed by the European Union and New Zealand, was leading the fight against new WHO guidance for ending the inappropriate marketing of baby foods and formulas, “after the White House had been heavily lobbied by the formula industry, arguing that trade should come before health.”

“These rich producer countries clearly wanted the freedom to dump these formulas onto developing world markets, especially in Asia, and have no concern about the impact this has on global health and the environment,” Rundall added in an email.

The new generation of sweetened flavored milks accounts for 50 percent of absolute growth in a market that is projected to rise to $70 billion in the next few years, according to Rundall, by “using misleading idealised health claims” that the products “are essential for child health and development.”

“But they are totally unnecessary and are fuelling the obesity crisis,” she added. “Thankfully the worst amendments being pushed by the USA did not succeed. What’s needed now is for governments to implement the Guidance and stop this tidal wave in its tracks.”

At a protection camp for civilians in Juba, the capital of South Sudan, UN peacekeepers from Bangladesh level the ground to remove stagnant water. ISAAC BILLY/UN PHOTO

While the United Nations approaches a major change at the top in selecting a new secretary-general for the next five years and conflicts across the globe continue to erupt, criticisms of UN management seem only to grow.

The topic of management skills of the next secretary-general came up repeatedly during the public hearings held by the UN General Assembly in question put to all the candidates this year, but such information was solicited by member states to the candidates and not by UN staff members themselves. Answers tended to be general.

A look at how UN employees feel about how the world body has been managed internally under the current secretary-general, Ban Ki-moon, whose term expires on Dec. 31, finds discontent.

During the nearly 10 years — two terms — that Ban has held the highest office at the UN, the rights of staff members have diminished, many people who were interviewed for this article say. Employees, some contend, now feel vulnerable regarding working conditions across the UN Secretariat. That body represents the core of the UN, numbering 41,081 employees, says the latest report of the secretary-general on staff demographics, from December 2015.

During Ban’s tenure, collective bargaining by employees through the various different unions of the Secretariat has been eliminated, for starters. In this environment, staff members feel their needs have been seriously overlooked.

Eduardo Díaz, a Venezuelan who has been active in one of the UN’s main unions and has worked for 17 years as an administrative assistant for the UN’s Department of Management, said that the relationship between workers and the administration under Ban have been “in decline.”

The Department of Management, an office in the UN Secretariat that stays out of the public eye but directly affects staff members, writes policies and procedures and sets strategies for human resources, finance and budget and other services.

According to the president of the Staff Union and to employees that challenged her leadership in the most recent election of labor representatives, Ban’s administration has weakened the UN’s biggest union, based in New York headquarters.

“The decline of the staff management relations did not necessarily start under Ban, but I do believe that he has further eroded the staff rights and benefits,” said Díaz, who participated in one of the parties that competed in recent Staff Union elections in New York.

Other UN staff members have publicly noted the need to draw more attention to management problems in the secretary-general selection process.

A letter published in July and signed by more than 130 UN employees and posted on the website 1 for 7 Billion (a campaign advocating for a more transparent secretary-general selection process), said that “the ability of UN staff to overcome the odds and successfully fulfil [UN] mandates depends fundamentally on leadership, including the political weight derived from the UN’s positive standing in the world. More than any other single factor, it is the person of the Secretary-General who is determinant.”

The International Labor Organization, one of the UN’s earliest agencies, has been advocating for stronger worker protections, fairness in the labor market and good business practices for decades worldwide. It considers collective bargaining a fundamental right of workers.

But the UN decision to eliminate that right of Secretariat staff members came through a decision made by Ban in a 2013 document, announcing that it had revised its relationship with UN staff members, based on recommendations from the General Assembly.

The “bulletin” outlined a fundamental change to the staff’s relationship with management by deleting the phrase “shall agree by consensus” — collective negotiation — from the text.

The change occurred after the International Monetary Fund, as a recipe to improve the economic recovery in Europe, had suggested moving away from what it called market “rigidity,” a concept circulating most recently since 2012 and elaborated on in the 2014 book “Jobs and Growth: Supporting the European Economy.” The book, published by the International Monetary Fund, proposed to dismantle collective bargaining to create more jobs.

One large trade union, the Public Service International (PSI), based in France and representing more than 20 million workers in 669 unions in 154 countries, reacted to the UN’s decision to remove collective bargaining. The PSI approved a November 2013 resolution saying that eliminating the right to reach agreement by consensus with the UN’s staff union was “especially hypocritical coming from the global organization dedicated to peace, social justice and upholding the Universal Declaration of Human Rights.”

Removing negotiating rights may go against the International Labor Organization guidelines, but because the UN is not a country, it cannot be a signatory to the agency’s conventions. As the Coordinating Committee for International Staff Unions and Associations of the UN system (CCISUA), an entity that encompasses 18 unions of the UN system representing more than 60,000 employees, said, staff members “are not protected by any national labour legislation or international conventions.”

An official in UN management who works for Yukio Takasu, the under secretary-general for management, confirmed that the UN “does not negotiate” with the unions but “consults” them on issues related to their welfare. He asked to remain anonymous because, he added, the “organization is very unforgiving.”

Since 2013, the UN has not had an operating union in its main headquarters. The New York Staff Union, the largest in the UN system, represents more than 25,000 employees, according to union representatives. But the December 2013 elections to choose the leadership of the union were marred by disagreements, making every step of the vote to renew the two-year presidency contested by at least two of the three parties that were running.

Given the differences, the party of the incumbent, Barbara Tavora-Jainchill, a professional-level employee with the United Nations Forum on Forests, called to organize new elections, while the party that claims to have obtained the highest number of votes rejected the proposal on the grounds that the voting was legitimate.

The victory of this party, led by Stephen Kisambira, an employee of the Department of Economic and Social Affairs who had previously presided over the Staff Union, was confirmed by an internal arbitration committee, but its rulings were not recognized by the UN administration. Kisambira insists that he is the current president.

The stalemate over the election was addressed publicly by Takasu, the under secretary-general for management, who said in May 2014 that the UN would intervene to find a solution to a “very, very unhealthy” situation. He said there were many issues the “UN would like to consult” with the New York union.

And while Tavora-Jainchill still holds the office of the president of the Staff Union in New York, traveling on behalf of staff members there and administering a budget, she considers her role ceremonial and said she was not consulted by UN higher-ups on issues related to staff members’ welfare, as set forth in the 2013 General Assembly document on management procedures.

For UN leadership, Tavora-Jainchill said, “it is wonderful to have a union that is weakened.”

A Brazilian national, Tavora-Jainchill added that she and staff members close to her have been “begging” for years to hold new elections, but Ban’s administration is “not serious” about the Staff Union.

The UN has approved several policies directly related to staff welfare since 2013, including flexible workspaces and compensation packages, without consulting the union.

First started as a pilot program in 2014, the flexible workspace policy established common areas where people below the director level would not have an assigned desk or space and is being implemented throughout the organization.

“We are left to believe that they consulted someone to reach this decision, which has a huge impact on the staff,” said Alberto Martin, who works for the UN Department of Management, “not to mention the effect that a shared workspace with no privacy would have in the products of the organization: reports, documents and letters.”

Meanwhile, as of Jan 1, 2017, the next secretary-general begins working with a five-year term. Facing the new leader will not only be wars, terrorism, famines, droughts, diseases, poverty and nearly unprecedented migratory flows, he or she will also face a long-disgruntled staff.

As Irka Kuleshnyk, president of the Staff Union in the UN offices in Vienna, said, “There has been a lack of understanding of what the staff needs in order to perform its functions in an optimal way, and to maximize the time and resources of the UN.”

“To have good staff-administration relations in the UN would not only be for moral reasons, but for practical reasons, to carry out the mandates of the organization,” Kuleshnyk added. “I would like to see a secretary-general that understands this.”

The letter from staff members posted on the 1 for 7 Billion site emphasized the uniqueness of their work in the field and behind desks, saying: “Every day, thousands of UN personnel travel into armed conflicts, work in displaced persons’ camps, investigate killings, torture and sexual violence, deliver food, shelter and medication, and strengthen rule of law and development.

We fight for human rights for all, respect for parliaments and the judiciary, the protection of sovereignty of vulnerable States, the credibility of elections, the health of mothers and children, for education, food, and water, for human habitats and the environment, for non-discrimination, for a global economy that benefits all, and much more besides.”

Madeleine Kuhns contributed reporting to this article. 

This article was updated to include the name of the head of the party contesting the staff union elections.

Celebrators at the opening of the New UN House in Ashgabat, the capital of Turkmenistan, on Nov. 26, 2016. The center acts as a hub for UN programs in the country. AMANDA VOISARD/UN PHOTO

The United Nations will swear in António Guterres as its ninth secretary-general on Dec. 12, when the organization will be only weeks away from the inauguration of Donald Trump and the potentially most threatening, hostile political opposition to the UN ever assembled in Washington, D.C. The UN will have to be prepared to respond and defend its record. Most likely, it will also have to fend off a wave of “fake news” and bogus sites designed to weaken public support in the United States and around the world. It will have to expand its audience reach as well.

By many accounts, the UN has fallen off the map.

Many factors are responsible for this situation. Inside the organization, competent staff members are silenced by an atmosphere that has made speaking out too big a risk to careers, even within the Secretariat or in high-profile missions around the world. Opaque, overburdened and ineffective UN information systems are largely not up to contemporary competition. Major international media have cut back coverage of the UN. Reporters who remain, denied access to officials and critical internal reports, are thrust into an adversarial role. Outside the UN, teaching and research about the organization have atrophied or have all but disappeared from most universities. Social media moves quickly into the vacuum, often with harmful disinformation.

Alarms are being raised around the world about what a Trump administration will mean for international programs and institutions. Among the many commentaries on various subjects, the British medical journal The Lancet took the unusual step of publishing a full-page editorial warning that American “commitment to global health and development could be at risk.”

Inside the UN, scores of officials and their staff at all levels are primarily preoccupied with the arrival of Guterres and his new team and worry about their futures in the organization. To make matters worse for UN officials, they see no coherent foreign policy being articulated by Trump, whose impulsive pronouncements and tweets — he has not held a news conference since July — flip-flop from day to day on issues important to the organization. He does not attend most national intelligence briefings, which are customarily given to presidents-elect.

“I don’t think people are thinking about the Trump administration,” a UN official said, “because, frankly, we really don’t know what to think. First of all, we don’t know who to talk to; there’s no foreign policy transition team. The transition from Ban [Ki-moon] to Guterres is what we are focusing on now.” That transition, he said, is going smoothly. By an accident of history, the UN and US are getting new leadership at the same time, putting a priority in both New York and Washington on internal decisions.

Several high-ranking UN officials, including Secretary-General Ban, have publicly condemned the harsh policies Trump endorsed during the presidential campaign and as president-elect, such as torture, religious profiling, mass deportations and bans on immigration. Trump’s harshest and most outspoken UN critic in recent months has been the high commissioner for human rights, Zeid Ra’ad Al-Hussein, who has called Trump a danger to the world. Trump’s attempts in recent weeks to tone done hardline threats, possibly only a tactic against public outrage, are met with some skepticism.

The appointment of Nikki Haley as US ambassador to the UN attests to Trump’s apparent lack of interest in ensuring a strong presence at the organization. Haley, the governor of South Carolina and an early critic of Trump, has no experience in multilateral institutions or foreign policy and seems more likely to have been chosen to meet pressures on the Trump administration to find women and appointees from minority groups for cabinet positions; her parents migrated from India. Haley’s departure for New York — she must first be confirmed by the Senate — also conveniently leaves in her place in South Carolina a lieutenant governor whose views are more in line with Trump’s.

Richard Gowan of the European Council on Foreign Relations and the Center for International Cooperation at New York University, described the president-elect in World Politics Review on Nov. 16 as demonstrating “an utterly incoherent vision of international security.”

At the same time, while the nationalists in the team that Trump is putting in place in his White House may know the world better, they are not shy about broadcasting their biases. Michael Flynn, the nominee for White House national security adviser, recently retweeted a message alleging that the new UN development goals would lead to a global ban on Christianity, according to a CNN review of his Twitter use. Unesco and the US Fund for Unicef, among others, have also been targets of online misinformation from obscure sources, which they have publicly refuted.

Ban Ki-moon, left, outgoing UN secretary-general, and António Guterres, incoming, as of Jan. 1, 2017. ESKINDER DEBEBE/UN PHOTO

In the US Congress, the solid control that Republicans now have over both houses jeopardizes the commitments to pay UN assessments and contributions to the UN, which the Obama administration honored for the core UN Secretariat, as well as its peacekeeping role and humanitarian work. UN agencies and many other international programs in the larger UN system could also see their US contributions slashed, with the UN Population Fund an obvious first target because of its support — shared by the UN as a whole — for safe, legal abortion.

There have already been calls on Capitol Hill to withdraw the US from the Human Rights Council, which falls under the purview of Hussein, and even the UN itself, though critics might pause at the thought of losing a permanent Security Council seat.

There is a lot to lose. By any measure, the US — and the American people — are the largest contributors to the UN system and its many activities around the world. In 2016, the US was assessed 22 percent of the organization’s regular budget, while China was billed roughly 8 percent and Russia, 3 percent. Assessments for the peacekeeping budget for 2016-2018 were calculated at 28 percent for the US, 6 percent for China and 3 percent for Russia. These assessments — dues derived from treaty obligations — are only part of the hundreds of millions of dollars that go to special appeals, UN agencies outside the Secretariat and other forms of contributions.

The cost of UN membership is emphasized and often exaggerated in writing that is critical of the organization. Several influential Washington think tanks with conservative, often anti-UN agendas and publications inform Republican opinion in the White House and Congress. Among them are the Heritage Foundation, the American Enterprise Institute and the libertarian-right Cato Institute. Gone from the US Senate are moderate outward-looking Republican supporters of the UN, like the late Charles Percy of Illinois and, more recently, Richard Lugar of Indiana, a Senate leader on foreign affairs, who lost a primary re-election bid in 2012 to a Tea Party challenger. Lugar later founded the Lugar Center, which focuses on global food security. In 2016, he was awarded the Fulbright Prize for International Understanding.

Among the general public, Republicans in the US routinely hold a more negative opinion of the UN than Democrats or Independents. A Pew Research Center poll in 2013 showed Democrats giving the UN a 72 percent favorable rating, with Independents at 60 percent. Republicans were not only on the low end of the scale, at 41 percent, but had also been steadily dropping over preceding years. A 2016 Gallup poll found that only 38 percent of Americans thought the UN was doing a good job; 54 percent said it was not and 8 percent didn’t know. The rest of the world leaves the US well behind in knowledge of how the UN works.

The Trump team has a fertile field in which to plant more doubts about the UN and galvanize action against it.

Peacekeeping stories you will never read

In 1999, Kofi Annan, UN secretary-general at the time, and his spokesman, Fred Eckhard, published media guidelines for UN officials that for the first time in the organization’s history introduced a formal policy of being “open and transparent in its dealings with the press.” The guidelines, initially devised for the peacekeeping department, gave all Secretariat staff members the right to speak to the media on subjects “within your area of competence and responsibility,” but to “provide facts, but not opinions or comment.” The guidelines are still in effect, according to the UN spokesman’s office, though they have languished and are disregarded repeatedly.

In no area has this unwillingness to listen to UN staff or allow them to do honest reporting been more harmful to the organization than in peacekeeping. Internal information on scandals of various sorts have been suppressed, ignored or shelved for unconscionable periods of time by higher-ranking people in a hierarchical system. Outsiders — in the media, nongovernmental organizations and sometimes courageous staff within the UN — make these scandals public, putting the organization immediately in a defensive position, as allegations fire up critics. Furthermore, UN peacekeeping operations are dynamic environments in which reporters can see the UN in action for themselves, often in dramatic post-conflict settings around the globe.

Every peacekeeping mission has a large public information unit dedicated to ensuring that the local population understands the mandate of the peacekeepers and to garnering international support for their operations. But lately, with shrinking newsroom budgets and the closing of international bureaus, news organizations don’t send as many reporters to cover far-flung conflicts that are only simmering, or cooling, when more dramatic stories compete. Western troops are sporadically involved as UN peacekeepers, with some exceptions, as in Mali, and the lives and contributions of “blue helmets” from developing countries carry far less significance in the international media.

In peacekeeping missions, communications officers are expected to sell trite “positive” stories to the media, while withholding comment on more complex or sensitive issues, from political negotiations to outbreaks of violence. Recent headlines — from attacks on civilians in South Sudan to sex abuse by peacekeepers in Central Africa and the cholera epidemic in Haiti — dominate in media, which give minimal coverage to other aspects of a mission, each one a complex operation taking more than tweets to explain fully.

Roberto Capocelli, a Fulbright scholar from Italy, worked as a human-rights public information officer with Monusco — the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo — the largest peacekeeping operation. The mission had been mired in bad news when a landmark human-rights trial took place in 2014, conducted by Congolese courts with assistance from Monusco and UN human-rights officials. A notorious war criminal, Bedi Mobuli Engangela, or “Colonel 106,” who had long terrorized communities in eastern Congo, was finally meeting justice.

Capocelli got to the trial ahead of the international media and with his deep knowledge of the issues, wrote up the story, stressing the UN’s contributions in logistics and protecting witnesses. He sent it for release to his superiors at the Office of the UN High Commissioner for Human Rights in Geneva. It was published two months later, virtually unchanged but buried in an obscure part of the UN Human Rights website. A video he made on the event was never used.

“In the end, we are not journalists,” Capocelli said recently. “But everyone had been complaining about impunity and after a huge investment of time and resources, [the UN] managed to do something good, especially at the moment the UN was under criticism for child abuse, corruption and inaction. Everyone is aware of this dynamic, how much the bureaucratic process can stop you from acting. I had the impression my work was not really needed.”

Peacekeepers from Uruguay helped to launch a soccer school in Goma, the Democratic Republic of the Congo, in 2014. SYLVAIN LEICHTI/UN PHOTO

Susan Manuel, a writer for PassBlue and an American journalist before joining the UN, worked in some of the most important and dangerous peacekeeping missions in the world, in addition to spending eight years in UN headquarters. During that time, she saw the relationship between UN missions and the media shrink from her first decade in Cambodia, South Africa, the Balkans and Afghanistan to her final posting in Darfur before retiring in 2012.

“In Cambodia, the UN peacekeeping mission, Untac [the United Nations Transitional Authority in Cambodia] was narrating the electoral process to a large international press corps,” she said in a written interview. “In the former Yugoslavia, I literally saw coverage of the UN improve after making an effort to get to know the local and regional journalists and provide them with concrete information. We told the story, even when the UN failed, even when the so-called UN-protected enclaves in Croatia and Bosnia were overrun. We public information officers were reporting these events in real time to media because these people were our responsibility.”

“In Kosovo we were narrating the growth of a new administration — with regular press briefings, interviews, guided visits for journalists,” she said. “We fed them constantly, and not with fluff, as these were discerning professionals, some of them veteran war correspondents.

“There were incidents of exploitation and abuse of the local population by peacekeepers in those earlier missions –particularly Cambodia and Somalia,” Manuel said. “But they didn’t threaten to bring down UN peacekeeping. Journalists knew these were complex and largely vital enterprises, which they covered on a daily basis. Scandals weren’t the only headlines.

“In Afghanistan, the UN mission was the most credible voice during a long saga of conflict, peace processes and human rights struggles, and the media depended a great deal on it.

“But when I arrived in Darfur [in 2011], the international media were gone, local media were ignored and the conflict was invisible, even — to a large extent — to the peacekeepers. We weren’t saying much about it.

“Senior UN mission officials disdained the sole opposition radio station, Dabanga,” she recalled. “Sometimes it was only when a blogger, Matthew [Russell] Lee, who is based in New York, read out reports from Dabanga on incidents in Darfur at the daily briefing by the secretary-general’s spokesman in New York that we could convince the mission leaders to respond. Or, I would figure out ways to release information surreptitiously by embedding it in otherwise anodyne messages or op-eds from the head of mission.”

When she retired from the UN, Manuel wrote in her end-of-assignment report on Darfur — where hundreds of thousands of civilians were killed as Sudan’s repressive government battled a regional rebellion from 2003 to 2009 — that UN policy makers needed to decide whether the peacekeeping information offices are there to promote only the “good news” of the mission or to “get and disseminate clear factual information about the situation on the ground related to our mandate,” which, Manuel added, “could enhance our credibility and lead to realistic responses.”

“Is it our role to report publicly on the conflict, as part of the mission’s security and protection of civilians’ mandate, or is it ‘none of your business,’ as one senior official told me after repeated requests to be included in information on fighting and human rights abuses?”

Shortly after Manuel left Darfur, Aicha El Basri arrived as spokeswoman for Unamid [the United Nations-African Union Mission in Darfur], lasting only eight months in what she called an “Orwellian” situation. In 2014, she dropped a Snowden-like bombshell, when she leaked thousands of code cables and emails to Foreign Policy magazine, which led to a series of articles excoriating the UN-African Union mission in Darfur. The Security Council and even the International Criminal Court demanded answers as El Basri, a Moroccan-American, had claimed the mission was covering up crimes against humanity.

Secretary-General Ban ordered an internal review, which confirmed five instances of underreporting or no reporting, of attacks against civilians and peacekeepers. He told the Security Council that “the media policy of UNAMID will be re-examined to ensure greater openness and transparency.” He exhorted other missions as well: “Ensuring that the UN speaks out consistently against abuses and identifies the perpetrators is a key goal of my Human Rights Up Front Initiative.”

How this advice has translated into action at the UN is hard to determine.

But recent crises involving peacekeepers indicate that the operations tend to react publicly only after the media has exposed them. By then, the mission has lost the opportunity to put its perspective out front authoritatively. The UN mission in Mali, on the other hand, has received more nuanced media attention, as the UN’s most dangerous mission. It gives regular press briefings and maintains an informative website, in French and English, Manuel noted.

“As only a consumer of media these days, it can be painful to read some of the headlines,” Manuel said, “because I know there are good people out there trying their hardest. But a UN perspective explaining the background is often missing. And if you go to the Facebook pages of some of the missions dealing with crises, it’s just la la land. The fact the sites have so few comments or shares tells me not many people are buying that version of reality.”

An information center in need of more resources

The hub for most news and documentation in the UN Secretariat is the Department of Public Information, known universally in the system as DPI, which was established in 1946 “to promote global awareness and understanding of the work of the United Nations.” An office of the spokesperson for the secretary-general was added later as part of DPI, but has since migrated (without cutting all links there) to the orbit of the the secretary-general’s staff, with independent functions as a conduit to media reporting on the organization. Agencies and programs outside the Secretariat, as well as major departments within headquarters, have their own communications specialists, but their work can be affected by practices and attitudes at UN headquarters.

Outside the UN, diplomatic missions of countries include public-affairs officers who reflect and explain the policies of their respective governments.

John Kerry, US secretary of state, signing the Paris Agreement on Climate Change in the UN General Assembly Hall, April 22, 2016, with a granddaughter. AMANDA VOISARD/UN PHOTO

At DPI’s founding, there were 51 mostly like-minded member countries in the UN. Now 193 countries are represented at the UN, offering many points of view on what news and information the UN should or should not be disseminating, particularly most recently on social developments like the recognition of LGBT rights or the promotion of women’s personal reproductive rights, to which numerous nations do not subscribe, at least in practice. LGBT issues are notably not in the Sustainable Development Goals.

“We are a melting pot of cultures poured into a bureaucracy designed in the 1950s,” Stéphane Dujarric, the secretary-general’s spokesman, said in an interview.

The Department of Public Information is also completely hamstrung by its mandate, officials acknowledge, and the head of the office, who ranks as under secretary-general, is not chosen primarily for his or her media skills, but is often a political appointee with little or no journalism experience. He or she must work under tight budgetary conditions deliberately framed to not give the department the tools it needs. Samir Sanbar, who headed the office from 1993 to 1997, said in an interview that he was flatly denied funds by the General Assembly budget committee to create a UN website. Instead, he stretched the resources of his existing staff to develop the platform.

“Even the idea of information going to the public remains always a question of arguments with member states,” he said. “Senior officials within the Secretariat were [also] not so keen on it. Peacekeeping, and even the office of the secretary-general, were afraid we were giving too much information to the public. I said: ‘This is what our job is! We need to reach the public. We need the public to support us.’ ”

Susan Markham, a former director of strategic communications at the UN from New Zealand and a frequent spokeswoman for many UN summits and global conferences, analyzed in a memo for PassBlue some of the constraints faced by the department:

• DPI is not able to reach out to the public of a member state to try to try to counter criticism of the organization by that member state’s government. Such activity could be interpreted as being contrary to the UN Charter (intervening in matters that are essentially within the domestic jurisdiction of a member state). DPI has been encouraged by member states to limit its activities to ‘informing’ the world about what it does, not doing crisis communications. The UN does not have its own voice or opinion, unless it is shared by a majority of member states.

• Budget cuts and constant restructuring forced on the DPI disrupts its effectiveness. DPI has gone through more ‘restructurings’ than any other UN department. First to go were information staff in the field, at a time when most organizations were touting the effectiveness of decentralization and opening field offices. DPI is supposed to tell the UN’s story to the world like a media or public relations company with a fraction of the resources. And, unlike most media or PR companies, DPI produces most of its material in more than six languages. Materials generally use ‘UN-speak’ rather than language that is clear and succinct. Journalists covering the UN find this particularly frustrating.

• DPI is micromanaged by member states through the General Assembly’s committee on information, which oversees everything DPI does. Endless reports have to be prepared for its annual meeting, and DPI staff spend days making presentations, monitoring the debate and (sometimes) lobbying on behalf of a favorite activity that might get the chop. Few if any of the delegates in the committee have any communications expertise. DPI is part of a bureaucratic and diplomatic organization.

• DPI staff are also not always journalists or communications experts, and the department is often seen as the dumping ground for UN employees that other departments want to get rid of. The head of DPI is often a political appointee. UN personnel policies make it hard for DPI staff to stay in jobs they are trained for — in radio, for example — and have to move up to management or be transferred to some other job.

• Much of the UN’s work relates to processes. Progress on solving complex issues like poverty, for example, is incremental and therefore not newsworthy. There are only so many public relations ‘tools’ that can be used — like creating International Days, or holding conferences and seminars, which are worthy but commonplace and often boring.

• DPI suffers from self-censorship. Although there is a great deal of freedom to develop the content of its materials, something perceived as critical by a member government or another UN department brings complaints that the UN takes seriously. Experienced DPI staff know the boundaries.

• When a scandal breaks out, the UN is not equipped to respond. In a bureaucracy, no individual is responsible. It takes time for an internal investigation to find out what really happened. Meanwhile, the media are continuing to publicize the wrongdoing. When the transgression is committed not by a UN employee but by peacekeepers or others who are not considered UN staff, there is even less sense of ownership and responsibility. Of course, this distinction is lost on the public, which considers all of them “the UN.”

During the tenure of Secretary-General Kofi Annan, his senior adviser and under secretary-general for communications and public information, Shashi Tharoor, an Indian, closed numerous UN information centers abroad, most in Western Europe. UN officials, past and present, think this was a serious mistake, because they had been useful service hubs for journalists and focal points for national governments. The UN continues to maintain centers in many developing countries, as well as one in Washington, which monitors Congress and government policies generally. The UN took a hit from the consolidation in 2003-2004 of two-thirds of the Western European centers. Only three remain: a regional center in Brussels and two in Geneva and Vienna, where the UN has sizable offices.

Stepháne Dujarric, spokesman for Secretary-General Ban Ki-moon. MARK GARTEN/UN PHOTO

Helmut Volger, a contributor to PassBlue from Berlin and author of A Concise Encyclopedia of the United Nations, published in German and English, is also a co-founder of the German UN Research Network (www.forschungskreis-vereinte-nationen.de).

“In general, the position of the United Nations in Europe with regard to the media has been severely weakened by the closure of nine excellent West European UN information centers by UN-DPI, being replaced by an ineffective and bureaucratic regional UN information center in Brussels,” he wrote in a memo for this article. “In Germany, for instance, that meant a clear-cut reduction of media attention from then on.”

Volger argues that there is little reporting now on the UN across Europe, except on the activities of the Human Rights Council in Geneva. “A typical example of the ignorance of the media is the UN office in Bonn,” he said. “Even though Bonn is the seat of the secretariat of the important UN Framework Convention on Climate Change, that does not motivate the German media to cover the work there sufficiently.” He added that there has generally been a widespread decrease in interest in the European media about UN topics, above all from television.

“In this situation, the national UN associations such as UNA-UK in Great Britain and the United Nations Association of Germany, try skillfully to draw the attention of the media to the UN topics through events such as panel discussions with high-level UN officials or ‘guided tours’ for journalists to UN peacekeeping missions,” Volger wrote. “But these efforts cannot replace full-time professional media relations work.”

Navigating the expanding ocean of digital media

Samir Sanbar, who pioneered the UN’s presence on the Internet two decades ago, says that when he wants to look up a UN document or other information on the UN now, he turns to Google. It is a common complaint: navigating the UN’s website is hard work and time-consuming.

“I agree that the search function on many of the UN.org sites is frustrating,” wrote Laura Kirkpatrick, who handles social media and writes for PassBlue. “I’ve tried to find data on both UN Women and the UN on the site, and had better results Googling the information, which led directly to the UN hosted pages I was looking for, rather than going through the site itself.

“It may be that the amount of information that comes through is too much for each department to handle, but it does seem that there are disconnects,” Kirkpatrick wrote. As an example, she cited the frequent updates issued by the secretary-general’s spokesman’s office via email. While the emails contain content that reads “For specific statements, search in http://www.un.org/sg/statements/sgstatsarchive.asp,” the link can take a user to a 404 error, a page where there may be a connection to the server the information is stored on, but the actual content isn’t there.

The press-center pages and certain program sites are not much better, as obsolete content and inconsistent mapping — how data is retrievable for search functions, for example — create diversions rather than direct routes. For instance, content from Unifem, the now-defunct predecessor to UN Women, is still returned in searches on the UN Women site.

“I think the problem is that the staff behind the basic sites like UN Women — but also the main sites for the Secretariat and General Assembly — are not trained to think digitally or strategically,” wrote Kirkpatrick, “but rather in general communications mode. Just consider the URL UnitedNations.org. When you type it into the Google search bar, you get a football team in San Francisco, with no path to the un.org website. No one has thought, ‘If I were a user, how would I search for this information?’ It seems like each section of the site has its own bureaucracy for filing away information and charting through the content, but there is not one cohesive thought behind the complete package.”

By contrast, the UN has developed extensive outreach through social media and emerging technologies, like digital broadcasts of live events that appear to have been given precedence over a traditional digital presence. The UN has several Facebook pages, and most entities, such as peacekeeping missions, have a Facebook presence, similarly with Instagram and Twitter, all delivering content and timely news.

The engagement of audiences via social media is erratic, sometimes depending on who is running the platform. From 2010, a Department of Public Information staff member, Nancy Groves, has directed all UN social media, including its Twitter account, which has nearly eight million followers; Facebook, two million; and Instagram, one million.

In an interview in May 2015 with Audiense, a site that monitors social media, Groves described how UN officials who initially disdained Twitter — “We don’t need to be on social media” — have realized its importance in delivering not only news and information but also visual images, including photographs and graphics. Her small team has kept bureaucratic vetting to a minimum while satisfying various special interests in the system and among member countries.

On the other hand, the department’s YouTube channel functions as little more than a parking lot for UN video products –many of them well-produced and informative programs designed for international broadcasters. Few people are using this critical platform for young audiences, with views for most clips in the 100s.

Nancy Groves, who handles the UN’s social media from the Department of Public Information.

More alarming, a brief YouTube search of the term “United Nations” indicates that conspiracy theorists are on the verge of dominating this platform: of the first six results that appear, the most popular (with 220,050 views) is “How Dangerous Is the United Nations?” Of those six videos, four involve an imminent “invasion” by the UN.

The social media environment seems fertile ground for anyone with paranoia and an Internet connection, and in the new world order underway, the UN will need to find tools to fight back. Groves recently confronted at least two attempts by outsiders to create fake Twitter accounts for the incoming secretary-general, António Guterres, who is regarded as having a good record in communications in his decade as UN high commissioner for refugees.

The refugees agency has used the social media account of its spokeswoman, Melissa Fleming, to advocate on behalf of the 65-million-plus people who are displaced globally. On Facebook and Twitter, Fleming posts several articles and images daily to keep the plight of refugees and migrants visible to a global audience. A hashtag created by the agency in June, #WithRefugees, and a UN Women-led campaign with the hashtag #He4She, to inspire men to support equality, have developed celebrity followings and “long tails,” or a more focused audience.

“The UN Development Program, Unicef and the World Food Program, among others, have sites and content that are parsed for digital delivery and easily retrievable data. Compare that to the General Assembly site or the secretary-general’s pages and it’s as if they are two different organizations,” wrote Kirkpatrick, about the many ways that content is delivered by the UN.

With an unfriendly US administration and a hostile Congress looming in Washington, the UN will require closer attention by the media, governments, nongovernment organizations and the foundations that support academic programs and other projects focused on the UN, since these spotlights have virtually disappeared.

Dujarric, Ban Ki-moon’s spokesman, describes an information environment that could overwhelm any institution — and the UN is a uniquely complex one. “In too many instances,” he said, “the UN should be defended by more outside voices that have a stake in its success.”

This long-form article was made possible through a grant from the Carnegie Corporation of New York.

If you liked this article and want to support high-quality journalism, please make a donation to PassBlue.

A new water capture and distribution project set up in Merger, Haiti, financed by the UN peacekeeping mission, Dec. 8, 2016. LOGAN ABASSI/UN PHOTO

WASHINGTON, D.C. — Strong American leadership at the United Nations would greatly enhance President-elect Trump’s foreign policy agenda. United States investment in the UN is an effective use of taxpayer dollars to serve the US military, diplomatic, economic and national security interests. UN peacekeepers, for example, cost one-eighth the expenses of US boots on the ground. And history shows that US leadership is critical to the UN’s efficiency and usefulness.

Combating terrorism and defeating ISIS and its metastasizing clones is clearly a top priority of the new administration. Yet failing and failed states remain breeding grounds for terrorism. Instead of sending US troops to places like Somalia, Lebanon, Mali, South Sudan or the Democratic Republic of the Congo, or asking the US military to engage in nation-building, UN peacekeepers are employed at a much lower cost. That is why 125,000 peacekeepers are currently operating in 16 conflict and post-conflict zones on four continents — the world’s largest military deployment.

UN peacekeepers are often undertrained, underequipped and, in some instances, have been charged with sexual abuse and negligence. Yet they are being held more accountable through stricter regulations, and the UN is committed to improving standards of conduct. With strong US, European and NATO advisers and support, peacekeepers can be an important force securing peace in conflict zones and helping to reconstruct nations in peace-building processes.

As a permanent member of the Security Council, the US can veto any peacekeeping mission; shape its authorization and mandate and exercise regular oversight. Lasting peace can be sustained through the collaborative work of the UN, regional organizations and member states by mediating disputes and building sustainable democratic institutions under the rule of law. If Trump wants to strengthen US security and make America safe, this is a significant way to do so around the globe.

UN specialized agencies harmonize global standards and ensure cooperative working relationships that advance US national security interests. Instead of negotiating separately with 193 countries bilaterally, the US can protect its citizens and enhance our economy most efficiently by establishing global safety and security standards in air travel, enforcing fair and balanced trade agreements, facilitating global telecommunications and postal services, protecting food security, containing pandemics and communicable diseases and forecasting tsunamis and hurricanes as well as fighting human trafficking, narcotics trade, counterfeiting and the sale of antiquities to fund terrorist organizations.

At any given moment, 30 ships at sea, 70 aircraft in the sky and 5,000 trucks on the ground enable the World Food Program to deliver food, much of it the beneficence of US agricultural productivity, to 90 million people in 80 countries, reducing the threat of instability in failed and failing states. The UN provides humanitarian assistance to people devastated by natural or manmade disasters and to 70 million refugees and displaced persons, mitigating the harsh effects of global instability. The UN vaccinates over half the world’s children, reducing the threat of communicable diseases that override sovereign borders.

If Trump seeks a better working relationship with Russia, the Security Council is a continuing deliberative forum that can facilitate this cooperation, although Syria is a gross example of the failure of unity among the council, with no consensus in sight.

Nevertheless, in October, Russia and the US and other members of the Security Council agreed to select the next UN secretary-general, António Guterres, the first former head of government to hold that position. He starts on Jan. 1. On many issues Russia, China and the US work together — for example, in supporting the Colombian peace agreement with the government and the FARC terrorists; opposing the Iraqi invasion of Kuwait; and imposing sanctions on Iran and North Korea. The UN has helped to resolve dozens of conflicts in Asia, Africa and Central and South America, including in Cambodia, El Salvador, Guatemala, Sierra Leone, Tajikistan, Timor-Leste, Haiti, Namibia and Mozambique.

Addressing the systemic causes of conflict and terrorism requires collaborations to raise global standards of living and economic opportunity. In the words of the 2016 Republican Party Platform, “Foreign assistance is a critical tool for advancing America’s security and economic interests by preventing conflicts, building stability, opening markets for private investment and responding to suffering and need with the compassion that is at the heart of our country’s values.”

Over the last 15 years, under the Millennium Development Goals, extreme poverty was reduced by 50 percent and infant and maternal deaths by 60 percent. The proportion of girls and boys in elementary school increased from 40 to 85 percent, and deaths from diseases like malaria, polio, HIV/AIDS and tuberculosis were dramatically reduced.

In September 2015, 193 nations in the UN General Assembly agreed to the 17 Sustainable Development Goals, which envision private sector/civil society partnerships to create jobs and economic progress, eliminate extreme poverty and promote good governance and the rule of law. If the goals are carried out, US leadership will help to address the underlying causes of conflict, terrorism and the refugee and migration crises as well as serve, in the words of the Republican Party platform again, as a “catalyst for private sector investment to fight corruption, strengthen the rule of law and create new markets for American goods and services in a competitive global economy.”

American dues to the regular UN budget are $621 million annually, and the US pays about $2.4 billion for peacekeeping, out of a $4 trillion total US budget, less than a 10th of 1 percent. Beyond that, voluntary contributions of dollars and expertise are given to UN programs that serve the US national interest.

When the US leads at the UN, real progress is made, and US national security is advanced.

If you liked this article, please consider making a US tax-deductible donation to PassBlue.

Rep. Chris Smith, Republican of New Jersey, helped lead the repudiation charge in the US House of Representatives against a recent UN resolution condemning Israeli settlements in Palestine. TIM LARSEN/GOVERNOR PHOTOS

While Washington is caught up in the unfolding drama about the extent and motives of Russian hacking and possible attempted manipulation of the 2016 American presidential election, another story is playing out around threats to “punish” the United Nations.

On Jan.5, the United States House of Representatives voted to repudiate the Security Council resolution on Dec. 23 that condemned Israel for its unending building of settlements on Palestinian land.

The UN was not the only target in this Congressional move. The administration of President Barack Obama and his secretary of state, John Kerry, were also censured for abstaining in the 15-member Security Council and allowing the resolution to pass 14-0. There is nothing legal or procedural that Congress can do to reverse the resolution.

The “passage of United Nations Security Council Resolution 2334 undermined the long-standing position of the United States to oppose and veto United Nations Security Council resolutions that seek to impose solutions to final status issues, or are one-sided and anti-Israel, reversing decades of bipartisan agreement,” the House resolution said. It added that the resolution “undermines the prospect of Israelis and Palestinians resuming productive, direct negotiations.”

Days after the Dec. 23 vote at the UN, Kerry further enraged Israeli supporters in Congress and President-elect Donald Trump when he warned in a speech at the State Department after the decision to abstain that Israel has a fundamental choice to make as it continues encroaching into Palestinian territory.

“But here is a fundamental reality,” Kerry said. “If the choice is one state, Israel can either be Jewish or Democratic, it cannot be both. And it won’t ever really at peace.”

Rep. Chris Smith, a Republican from New Jersey and one of the leaders of the charge in Congress, asserted, “With over three thousand years of Jewish history bound up in East Jerusalem and the West Bank, it is preposterous to assert that Israel has no legitimacy in defending its connections to this extraordinary heritage.”

The vote in Congress to “repudiate” the resolution condemning Israeli expansion was welcomed by Israel’s ambassador to the UN, Danny Danon, who hailed the bipartisan nature of the support for Israel. “I look forward to working with the new American administration to end the bias against Israel at the UN and to usher in a new era of accountability in the parliament of nations,” he added.

At the same time that the House of Representatives disavowed the Security Council resolution and Obama policy on Israel, members of the US Senate were beginning to work on legislation, promised late last year by Senator Lindsey Graham, Republican of South Carolina, to cut funds for the UN.

It is unclear how long it will take to complete this proposal or how devastating the cuts could be, but with Trump tweeting insults about the UN as “just a club for people to get together, talk and have a good time,” defunding measures could likely be endorsed in the White House.

Representative Smith, who pressed for the “repudiation” resolution in the House of Representatives, is chairman of the subcommittee that monitors US relations with the UN and other international organizations, and he has a long record of opposition to them. He has been the leader of an anti-abortion caucus in Congress for 34 years and was instrumental in having US contributions to the UN Population Fund, or UNFPA, eliminated twice — under Presidents Bill Clinton and George W. Bush.

Smith, a deeply religious and dedicated Roman Catholic, who opposes abortion for any reason and is at best ambivalent about family planning, has been focused particularly on China and its one-child policy. That has been abandoned as the Chinese government sees its workforce is not keeping up with demand.

Smith’s determined opposition to funding UNFPA overrode the findings of a White House delegation sent to China in the spring of 2002 that found no evidence that the Population Fund was complicit in coercive and brutal forced abortions. Colin Powell, secretary of state at the time, agreed that funds to UNFPA, which he said did “invaluable work,” should be released, but Bush cut them off.

The money at stake, $34 million annually, was not a lot but it hurt. Other nations tried to fill the gap, and Jane Roberts, an American teacher in California, and a colleague founded an ad hoc organization called 34 Million Friends of UNFPA, asking for donations. Roberts said in a recent email that she was gearing up for another campaign.

The Population Fund is the world’s largest provider of family planning and works in more than 150 countries and territories that together contain a large majority of the global population. Under the motto “Delivering a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled,” it has made great strides in improving maternal and child health.

The Obama administration restored and increased US funding to UNFPA, so Smith will no doubt work to have it slashed or cut off completely again under Trump.

Larysa Ziobina, head of the newborn department at Kramatorsk maternity center, in Donetsk, Ukraine, said that since the war began, more women who come to the clinic are at risk of miscarriage and more newborns need intensive care. PHOTO COURTESY OF UNFPA

Imagine yourself a pregnant woman in Syria making her way on foot to a refugee camp when suddenly you go into labor. The United Nations Population Fund is there to save you and your baby’s life. That is what UNFPA does. I have seen their work on site in Mali and in Senegal.

President Trump has signed an executive order that says the United States will stop funding any foreign or international organization that promotes “the performance of abortion or sterilization as a method of family planning.” Even counseling or providing information on abortion would trigger a loss of US government contributions. Obviously, one target is the UN Population Fund, which, if truth be told, firmly rejects abortion as a method of family planning but promotes safe motherhood and access to a choice of contraceptives and gender equality, while also battling gender-based violence and AIDS.

This global gag rule, first enunciated through a policy announced in Mexico City at a UN population conference in 1984 by the Reagan administration, is part and parcel of Trump’s broad assault on the UN.

On July 22, 2002, when President George W. Bush canceled a contribution of $34 million to UNFPA, I was mad, really mad. As a retired French-language teacher and tennis coach in Redlands, Calif., I decided to ask 34 million people to take a stand for the women of the world with a donation of one dollar each. Lois Abraham had the same idea, and we became partners. This became a moderately successful grass-roots movement to which I gave my all. It made hundreds of thousands of people aware of UNFPA and its humanitarian work, and 34 Million Friends, www.34millionfriends.org, has garnered to date a lovely $4.3 million.

With envelopes pouring in to support the Population Fund, the agency invited Lois and me to New York in October 2002 to meet us two “crazy ladies” and present us at a press briefing. It so happened that during that same month, the agency’s US Committee (now called Friends of UNFPA) was sponsoring a Family of Woman exhibition in the lobby of the UN.

I was a member of the honorary committee for this exhibition, as was — guess who — Donald Trump. Doesn’t it stand to reason, then, that Trump fully supported UNFPA at the time and allowed his name to be used in conjunction with the one US organization raising money and awareness for the just-defunded UN Population Fund?

Now as president, Trump is clearly going to stiff the UN agency of US support, thereby restricting vulnerable women’s access to health and autonomy in making reproductive choices.

Ever since the election of Trump, I have labored over my plan to reinvigorate 34 Million Friends. I’m spending hours printing out my “contacts” documents and going through my 15 notebooks that summarize all my past travels and media appearances. People will say that political organizing should come before money-raising but I want people to do both. I’m thinking of asking individuals for $34 each this time, which would help train a midwife or buy contraceptive supplies. The women of the world have it tough, and the US under Trump has now made it tougher.

We the people can step into the breach. I, for one, deeply appreciate the hugely beneficial humanitarian function and work of the UN, and particularly the UN Population Fund, in our complex, difficult world.

A participant at the annual UN Commission on the Status of Women conference in March 2016. RYAN BROWN/UN WOMEN

The annual meeting of the United Nations’ Commission on the Status of Women, held in New York every March, may be in trouble because of uncertainty and fear about the Trump administration’s attempt to ban immigration from seven Muslim-majority countries. One major group has announced it is pulling out, and calls are being heard to move the meeting to the UN’s base in Geneva.

The 102-year-old Women’s International League for Peace and Freedom will not be participating this year in the global meeting. The league, based in Geneva, is the oldest women’s peace group in the world. It is led by Madeleine Rees, a lawyer who worked for the UN in Bosnia, where she helped expose sex trafficking by UN peacekeepers. Rees’s role was portrayed in a 2010 film, “The Whistleblower.”

In an announcement released on Feb. 9 and posted on its Twitter page, the league said that in light of the Trump ban announced on Jan. 27 as “a matter of principle, and in solidarity with our partners from excluded countries,” the group known as WILPF, which brings women from all over the world to participate in the annual UN conference, will not take part in the 61st Commission on the Status of Women session.

In explanation, it said, “WILPF warns that the absence of women from countries affected by the recent US travel ban undermines the basic premise of the CSW as being an inclusive and participatory process and threatens its legitimacy.” It did not acknowledge that the Trump ban has been frozen for now.

The UN conference attracts thousands of women from governments, civil society and other walks of life to assess progress on women’s equality, gathering in workshops and other formats. It finishes with an “outcome document” that clarifies the annual theme and recommendations going forward.

This year, the theme is “women’s economic empowerment in the changing world of work,” and the conference is March 13 to 24.

The overall mission of the commission, which was established by the UN’s Economic and Social Council and first met in 1947, is to “raise the status of women, irrespective of nationality, race, language or religion, to equality with men in all fields of human enterprise, and to eliminate all discrimination against women in the provisions of statutory law, in legal maxims or rules, or in interpretation of customary law.”

Given, however, the exclusionary nature of Trump’s immigration ban of people trying to enter the United States from Iraq, Iran, Libya, Somalia, Sudan, Syria and Yemen, the women’s league felt compelled to boycott the CSW, it said.

The travel ban is now in legal limbo, though, after American courts rejected Trump’s original plan. A new version is apparently being written by the White House.

“Women from the countries subject to the ban have either been denied visas or cannot, with any confidence, attend the CSW,” the league said in its statement in English and Arabic.

Even though the immigration ban was frozen by a US federal judge on Feb. 3, the decision was upheld by a federal appeals court and people from some of the banned countries are entering America again, there is much concern among many civil-rights parties and others that traveling into the US from the named countries could mean encountering difficulties.

Talk had been made by a handful of powerful groups lobbying to have the women’s conference postponed in New York and moved to Geneva, one person knowledgeable about the discussions told PassBlue. Most groups oppose this proposal, the person added.

Conflicts over the women’s conference amid the Trump ban have been brewing since the order was made, on Jan. 27. But there is no mention of tensions on the website of UN Women, the conference organizer and the lead entity at the UN promoting women worldwide.

The most public airing of problems with the 61st session appeared in an essay published in OpenDemocracy, the open-source journal. In an article by Lisa Davis and Yifat Susskind on Feb. 4, they wrote: “Every March, when the annual UN Commission on the Status of Women (CSW) meetings are held, women’s rights activists seize the chance to come to New York City, lobby global policymakers and collaborate with each other.

“Now, many are asking themselves how we keep the doors open for those activists from banned countries. Some are questioning if CSW should be postponed or even moved to Geneva, in solidarity with those who cannot attend.”

Davis is a human-rights advocacy director for Madre, a global organization based in New York that promotes women’s rights, and a professor at the City University of New York Law School. Susskind is the executive director of Madre. Their article said that canceling or moving the conference would not be fruitful.

“Far from it,” they wrote. “Substantial civil society participation at CSW in New York this year would be an act of solidarity, creating a critical show of resistance against autocracy and the US administration’s xenophobia and misogyny.”

Right now, they added, “we should be talking about how to best leverage CSW in New York to make a stand for global gender justice in this moment of crisis. Rather than accommodating Trump’s exclusionary agenda, we should be asking ourselves how to fortify and expand our movements amidst the global rise of right-wing authoritarianism, closing borders, and shrinking civil society spaces.”

Now that WILPF is “girlcotting” the conference, it could pave the way for more organizations to do the same, although none have stepped forward.

At the same time, the idea of holding the conference in New York and another in April in Geneva — for people who might not be able to attend in March — has been broached, said a person involved in discussions.

“If WILPF is ‘girlcotting,’ that is quite significant,” said Tanya Domi, an adjunct professor of international and public affairs at Columbia University who has worked on gender and other matters in the Western Balkans. “Led by the morally strong leadership of Madeleine Rees [of WILPF] — such an action sends a powerful message to the UN and its institutions.”

Sanam Naraghi-Anderlini, an Iranian-born feminist who lives in the US and is executive director of the International Civil Society Action Network, also wrote in a Jan. 30 essay in OpenDemocracy about the possibility of women from banned countries being unable to attend the UN conference.

As to the recent move by WILPF and the CSW, Anderlini said in a recent email to PassBlue: “I’d like to see the UN itself inviting women from the 7 countries to open the CSW & keynote each day’s session. One member state cannot & should not determine who has access to UN events.”

“I appreciate the sentiment & wanting to hold CSW in a country that welcomes the citizens of all UN member states,” she added, about a meeting in Geneva. “So I think we should be everywhere — at CSW in New York & at alternate CSW gatherings elsewhere.”

Jessica Neuwirth, the founder of Donor Direct Action, which supports women’s-rights organizations “working on the front lines,” voiced a more optimistic note about the recent US legal decision on the immigration ban and its effects on the women’s conference.

“We were very glad to see that United States courts have halted implementation of the discriminatory measures President Trump attempted to put in place,” Neuwirth said in an email. “We are hopeful that American constitutional safeguards will continue to block discrimination on the basis of religion and national origin, in which case all those planning to attend the CSW would be able to do so.”

The American actress Anne Hathaway was the main guest at a UN celebration marking International Women’s Day on March 8, 2017. The event preceded the annual women’s conference at the UN, March 13-24. RYAN BROWN/UN WOMEN

Despite fears that efforts by President Trump to bar visitors to the United States from a number of Muslim majority would limit attendance at this year’s annual United Nations conference on women in New York, UN officials have kept saying there will be record participation. On the first day, however, people were more worried about the forecast of a blizzard in the region disrupting events than they were about visa problems. (The UN announced at the end of the day it would close on March 14 because of the storm.)

From March 13 to 24, the 61st Commission on the Status of Women is convening at UN headquarters and environs, offering about 300 side events and drawing thousands of nongovernment organizations. UN Women, as the organizer, has been boasting about the sheer volume of participants and activities while at the same time has been somewhat dismissive regarding problems people might be encountering in attending the event.

One international nongovernmental women’s group in the Netherlands, WO=MEN, is compiling information on women from overseas who were denied visas to attend the UN conference.

Some major organizations have dropped out in sympathy to participants who may not be able to enter the US because of the effect of the two Trump immigration bans, one of which was dropped but may have left lingering results. The new one takes effect March 16 and restricts entry of people from six countries: Iran, Libya, Somalia, Sudan, Syria and Yemen. The original ban on Iraqis was lifted. But various reports from women’s groups in the US and abroad said they knew of women from other countries, including Afghanistan, Bangladesh, Nepal and Peru, who were denied visas to attend the women’s conference.

The theme of the conference is women’s economic gains in the workplace, but given the sizeable number of events, topics have strayed, with many delving into the sad perennial of ending violence against women. That was the theme in 2013, when Michelle Bachelet, now the president of Chile, headed UN Women. The problem has not gone away.

As for economics, on global average, women make 77 cents for every dollar earned by men for work of equal value, according to an International Labor Organization “Women at Work Trends” report. The global gender pay gap is 23 percent, but in some countries the figure is much higher, and it will take 70 years — two generations — to close the gap.

Only 49.6 percent of working-age women are represented in the labor force globally, compared with 76 percent of men. That doesn’t mean many women are lounging around: the issue of unpaid care work will also be debated at the conference.

Focus on the wage gap kicked off the conference on March 13, with four men speaking at the opening program before Phumzile Mlambo-Ngcuka, as the head of UN Women, could take her turn. Government delegates and civil society representatives — a healthy mix of men and women — from every region showed up for the first talkfest, held in the UN General Assembly Hall, from Chile to Denmark, Italy to United Arab Emirates, Iceland to Kenya, Canada to South Africa.

In the evening, Mlambo-Ngcuka and celebrities, like the American actress Patricia Arquette, planned to mark the global inequity gap with an “equal pay platform of champions” and a hashtag: #StopTheRobbery.

More symbolically, the wage gap will be noted on March 14, when the conference will pause for five minutes at 4:10 p.m. and “there is 23 percent of the workday left,” UN Women said. The blizzard may push that “pause” to March 15.

The conference is also tackling the issue of unpaid care work, as more resources are being used to pay attention to the fact that women and girls still shoulder a large role caring for others in the home and outside it. The conference will emphasize that this unfair burden hurts all of society and not just females, as women take on 2.5 times more unpaid work than men.

How the UN debates will help improve productive employment and decent work for women while eliminating unpaid care work will be closely watched. The aim is to push governments to ensure equal wages and equal societies. These ambitions can be achieved, UN policymakers say, through the world’s sustainable development goals. But the SDGs, as they are known, are voluntary commitments. Paid parental leave, more men sharing care work and affordable childcare would go a long way in getting more women into the workforce. Few countries can say they have such setups.

Iceland, for one, has a plan: its minister of social affairs and gender equality (a man, Thorsteinn Viglundsson) is discussing at the conference a government proposal requiring companies and institutions with more than 25 employees to carry out an equal-pay certification system in Iceland — to literally receive a stamp of approval. It’s being called the Equal Pay Standard, and the hope is that other countries will emulate it.

Opening day of the annual women’s conference, March 13, 2017. RICK BAJORNAS/UN PHOTO

Beyond the conference’s wage-gap theme, a potential logistical problem for participants emerged when the US, the host country for the UN, issued travel bans limiting access to its nation. The first ban, introduced in January, focused on seven fragile states, Iraq, Libya, Somalia, Sudan, Syria and Yemen and Iran. While the first ban was rescinded, another ban emerged, to be launched two days into the women’s conference, limiting travel by six of the countries, excluding Iraq. (On the first day of the conference, the delegate seats for Iran and Iraq in the General Assembly were empty.)

Yet UN Women representatives have repeatedly said that the bans have not affected conference plans. At a March 7 media briefing, Lakshmi Puri, deputy executive director of UN Women, estimated that more than 8,600 nongovernmental organizations and individuals would participate and more than a thousand government delegates from around the world were registered to attend.

“As far as visa issues, vis-à-vis civil society participation,” Puri said, “we have not heard of major problems. We’ve spoken to the US mission [to the UN] to facilitate and also they are receiving civil representatives seeking help in case they have difficulties.”

The spokesman for Nikki Haley, the US ambassador to the UN, said last week that he was not aware of the US mission working with UN Women on participants’ visa problems.

But as previously reported by PassBlue, some nonprofit groups have withdrawn participation in solidarity with women from countries banned by the US, including the Women’s International League for Peace and Freedom, the oldest women’s peace group in the world.

Following suit, Ruchira Gupta, the founder of Apne Aap Women Worldwide, a group based in India committed to ending sex trafficking, is also not attending. Gupta is a renowned presenter at CSW events and was awarded a Woman of Distinction prize by the NGO Committee on the Status of Women, NY, in 2015.

In addition, Masimanyane Women’s Rights International, the South African partner of the International Women’s Health Coalition, announced the organization was boycotting the conference. The coalition released a statement, saying, in part: “IWHC believes that the Trump Administration’s executive orders display a fundamental disrespect for women, racial justice, equality, religious tolerance, and human rights.” (Notably, Mlambo-Ngcuka of UN Women is South African.)

Madre, a network of women’s groups, announced on March 13 an initiative called No Borders on Gender Justice, made up of women’s, LGBTIQ and immigrant justice organizations. The coalition, which is participating in the women’s conference, said that the new executive order by the Trump administration is the “latest in an exclusionary trend that prevents women from exercising their rights to political participation at UN Headquarters.”

The Dutch nonprofit group WO=MEN is keeping track of women activists who have been unable to come to the conference or who were afraid to come, based on the politics of Trump toward women and Muslims. And the Global Network of Women Peacebuilders had to cancel one of its conference events because its participants from Libya were unable to come.

As an Icelandic visitor to the conference, Bryndis Birgisdottir, said, “I filled out all the paperwork to come here but I never knew if I could get in.”

This article was updated.

Donald Trump in his first weekly address to the nation, Jan. 28, 2017. His proposed cuts in his first national budget could leave the United Nations gouged but details are vague. CREATIVE COMMONS

In his first national budget plan, released by the White House today, President Donald Trump proposed an aggressively pro-military and security-obsessed agenda that could severely cut funds to the State Department and the United Nations. Numerous other international programs run by various government agencies, which benefit many people around the world, are also being targeted.

These extreme steps show barely a shred of concern for global opinion or for the needs of people in peril outside the US. The message is that citizens of the richest country on earth must come first.

“Our aim is to meet the simple but crucial demand of our citizens — a Government that puts the needs of its own people first,” Trump wrote in his introduction to the document, compiled by the White House Office of Management and Budget. True to all his trademark isolationist and discriminatory rhetoric, Trump boasted that this would be his way of making, as the document says, “America Great Again.” Again?

The budget plan goes to the US Congress next, where it could find more opposition than the president’s team may expect. Congress is mired in a growing revolt against a national health policy that Trump backs, mostly because of its draconian willingness to risk the loss of insurance coverage for tens of millions of Americans.

No specific UN programs or agencies are elaborated on in the proposed national budget, leaving it up to both houses of Congress to fill in the blanks. It is widely assumed, however, that members of Congress are likely to target the United Nations Population Fund, the largest global provider of family planning and maternal health care, as well as the UN Human Rights Council.

In her confirmation hearing on Jan. 18, Nikki Haley, the US ambassador to the UN, said: “We need to go into every part of the organizations of the UN, but one in particular that you can look at is the Human Rights Council, and you really have to question what is the goal of the Human Rights Council when they allow Cuba and China to serve on those.”

On March 16, Haley said in a statement about the Trump budget proposal: “In many areas, the UN spends more money than it should, and in many ways it places a much larger financial burden on the United States than on other countries.” Yet the payoff, she did not acknowledge, is that the “burden” gives the US enormous control at the UN.

Some officials in Trump’s own team as well as Congressional leaders and scores of military and intelligence officials past and present have questioned such a withdrawal from the world. Speaking in Tokyo on March 16, 2017, before meeting the Japanese foreign minister and the prime minister, US Secretary of State Rex Tillerson told Japanese reporters that he recognized the challenge: “[To] be able to do a lot with fewer dollars.”

Defense Secretary James Mattis has said publicly: “If you don’t fund the State Department fully, then I need to buy more ammunition.” Certainly, he won’t be short of cash.

Here are provisions in the Trump budget proposal that will most affect US foreign policy and international organizations, with language verbatim:

• The President’s 2018 Budget requests $25.6 billion in base funding for the Department of State and USAID, a $10.1 billion, or 28 percent, reduction from the 2017 annualized CR [continuing resolution, which allows government offices to go on functioning in a budget stalemate].

• Additional steps will be taken to make the State Department and USAID leaner, more efficient and more effective. These steps to reduce foreign assistance free up funding for critical priorities here at home and put America first.

• [t]he Budget seeks to reduce or end direct funding for international organizations whose missions do not substantially advance U.S. foreign policy interests, are duplicative, or are not well-managed. [No specific examples given.]

• Reduces funding to the UN and affiliated agencies, including UN peacekeeping and other inter-national organizations, by setting the expectation that these organizations rein in costs and that the funding burden be shared more fairly among members. The amount the US would contribute to the UN budget would be reduced and the U.S. would not contribute more than 25 percent for UN peacekeeping costs.

• Eliminates the Global Climate Change Initiative and fulfills the President’s pledge to cease payments to the United Nations’ (UN) climate change programs by eliminating U.S. funding related to the Green Climate Fund and its two precursor Climate Investment Funds.

• Refocuses economic and development assistance to countries of greatest strategic importance to the U.S. and ensures the effectiveness of U.S. taxpayer investments by rightsizing funding across countries and sectors.

• Provides $3.1 billion to meet the security assistance commitment to Israel, currently at an all-time high; ensuring that Israel has the ability to defend itself from threats and maintain its Qualitative Military Edge.

• Provides sufficient resources on a path to fulfill the $1 billion U.S. pledge to Gavi, the Vaccine Alliance. . . . Provides sufficient resources to maintain current commitments and all current patient levels on HIV/AIDS treatment under the President’s Emergency Plan for AIDS Relief (PEPFAR) and maintains funding for malaria programs. The Budget also meets U.S. commitments to the Global Fund for AIDS, Tuberculosis, and Malaria by providing 33 percent of projected contributions from all donors, consistent with the limit currently in law.

• Allows for significant funding of humanitarian assistance, including food aid, disaster, and refugee program funding. This would focus funding on the highest priority areas while asking the rest of the world to pay their fair share. The Budget eliminates the Emergency Refugee and Migration Assistance account, a duplicative and stove-piped account, and challenges international and non-governmental relief organizations to become more efficient and effective.

• Reduces funding for the Department of State’s Educational and Cultural Exchange (ECE) Programs. ECE resources would focus on sustaining the flagship Fulbright Program, which forges lasting connections between Americans and emerging leaders around the globe.

• Reduces funding for multilateral development banks, including the World Bank, by approximately $650 million over three years compared to commitments made by the previous administration. Even with the proposed decreases, the U.S. would retain its current status as a top donor while saving taxpayer dollars.

Other US government departments’ international programs are also affected: 

• The Department of Agriculture: The McGovern-Dole International Food for Education and Child Nutrition Program — supporting child development and food security in low-income, food-deficit countries and primary education for girls globally through donations of American food and technical assistance — is eliminated because, the budget proposal says, it “lacks evidence that it is being effectively implemented to reduce food insecurity.”

• Health and Human Services: Reduces the National Institutes of Health’s spending relative to the 2017 annualized CR level by $5.8 billion to $25.9 billion, and eliminates the Fogarty International Center. . . . The Budget also reforms the Centers for Disease Control and Prevention through a new $500 million block grant to increase State flexibility and focus on the leading public health challenges specific to each State. [The CDC is a major player worldwide on health information and up-to-date data.]

• The Department of Labor: The budget focuses the Bureau of International Labor Affairs on ensuring that U.S. trade agreements are fair for American workers. . . . It eliminates the Bureau’s largely noncompetitive and unproven grant funding, which would save at least $60 million.

• Defending the Department of Defense: Trump’s rationale for a ballooning military budget:

There is a $54 billion increase in defense spending in 2018 that is offset by targeted reductions elsewhere. . . . We must ensure that our courageous servicemen and women have the tools they need to deter war, and when called upon to fight, do only one thing: Win.

As for the response from the UN, this statement was released on March 16, 2017, by Stéphane Dujarric, the spokesman for Secretary-General António Guterres: “The Secretary-General fully subscribes to the necessity to effectively combat terrorism but believes that it requires more than military spending.

“There is also a need to address the underlying drivers of terrorism through continuing investments in conflict prevention, conflict resolution, countering violent extremism, peacekeeping, peacebuilding, sustainable and inclusive development, the enhancement and respect of human rights, and timely responses to humanitarian crises.

“The international community is facing enormous global challenges that can only be addressed by a strong and effective multilateral system, of which the United Nations remains the fundamental pillar.”

Members of Team Nine of the WHO Ebola vaccine trial, working in Katongourou, Guinea, in July 2015, using the vaccine rVSV-EBOV, which was found to be “highly effective” against the fatal disease. S. HAWKEY/WHO 

GENEVA — In late May by secret paper ballot, all 194 member states of the World Health Assembly that have paid their dues will cast their votes for one of three final candidates in the first-ever election of the planet’s top doctor: the director-general of the World Health Organization.

The candidates are Tedros Adhanom Ghebreyesus, 52, a former government minister of Ethiopia with a Ph.D. in community health, who goes by his first name; Dr. Sania Nishtar, 54, a cardiologist from Pakistan; and Dr. David Nabarro, 67, a medical doctor and official of the UN, from Britain.

As the eighth head of the WHO, the victor on May 23 will be faced with rehabilitating the agency’s image, which was damaged over its delayed response to the Ebola epidemic in West Africa in 2014. He or she will have to take the reins of a reform initiated by Dr. Margaret Chan, the outgoing director-general, who is Chinese; lead a Balkanized structure of six semiautonomous regional and 150 country offices; and reinspire morale among some 7,000 staff members, whether at their desks on the bucolic campus for humanitarian headquarters here in Switzerland or braving conflict zones like Yemen to vaccinate hundreds of thousands of vulnerable children.

Moreover, the WHO will have to do much more with much less if President Trump’s plans to cut US aid to international organizations gets through Congress, including a new one to merge USAID into the State Department. The US is the top donor to the WHO, with $747 million committed as of December 2016. Britain — WHO’s third-top donor — has also indicated it may reduce funding unless the WHO adapts more stringent reforms. The Bill & Melinda Gates Foundation is the second-largest donor to the agency, with $629 million at the end of 2016.

Despite the three candidates’ many promises, they face a grim reality. The current agency budget is already $300 million short of full financing. And the WHO is in danger of losing its leadership role in sectors like emergency response and health metrics, a system developed at the WHO in the 1990s that has moved to the University of Seattle in Washington, with financing by the Gates Foundation.

The WHO must respond to more crises around the world while shoring up ill-equipped national health systems and retaining its power to convene, inform and persuade disparate cultures of everything from stopping smoking to destigmatizing depression. The WHO is also leading a campaign to halve medication-related errors by 2022.

Tedros, Dr. Nishtar and Dr. Nabarro all claim to be undaunted by prospects of what the American foreign-policy and global health expert Laurie Garrett calls a “hideous job.”

The new director-general will have no time to get settled before confronting what the UN is labeling the worst humanitarian crisis in its history: the anticipation of major outbreaks of disease along with a famine and drought looming from northern Nigeria to Yemen that is expected to sweep through the Horn of Africa.

As a WHO spokesman, Christian Lindmeier, said, “2017 will bring the biggest challenges, and we’re in the middle of it.”

And there are other crises in the making:

• The third major yellow-fever outbreak in two years is hitting Brazil and parts of Africa, threatening urban areas. “We haven’t seen an urbanized yellow-fever epidemic ever,” said Garrett, a senior fellow for global health at the Council on Foreign Relations in New York. Because of a vaccine shortage, these critical areas are being inoculated with diluted drugs.
• In China, pigs have been piling up in rivers killed by the H7N9 bird flu virus, which became a pandemic that the WHO helped to quell eight years ago. Late last year, a new strain began jumping to humans; in 2017 so far, more people have died than the cumulative numbers of previous years. “We’re facing the largest pandemic threat in 100 years,” Guan Yi, a Hong Kong University disease expert, told Science magazine in February.
• In the next decade, a pathogen designed on a computer screen by terrorists could kill as many as 30 million people within a year, Bill Gates told a security forum in January. “Governments must prepare for these epidemics the same way we prepare for war.”

The question of just how much power and discretion the director-general has over all these potential crises and developments inevitably arises: 80 percent of the WHO budget comes from voluntary contributions, many of them earmarked for projects predetermined by a handful of large donors working with WHO teams. Only 25 percent of the WHO staff work in Geneva and report directly to the director-general. Of the $4.4 billion budget, the director-general “has a $1.5 billion pot to disburse,” said Gaudenz Silberschmidt, the WHO director of partnerships and nonstate actors (as in donors, in international-community parlance.)

Campaigning for the job

The election in May has all the trappings of a global Oscar night and seems to be taking its cues from the 2106 campaign for the UN secretary-general, during which candidates presented their platforms in public venues — including a debate held by Al Jazeera at the UN — and took to Twitter and elsewhere on the Internet. The open process attracted global public audiences in what had been a closeted ritual for an elite club of nations for decades. Ultimately, António Guterres, a former head of the UN refugee agency and prime minister of Portugal, was selected by the UN Security Council in a private vote.

Dr. Sania Nishtar, 54, of Pakistan. 

The WHO says it started planning a more democratic exercise years before the UN secretary-general selection process. Until this year, the WHO leader was selected by its 34-member executive board. In January, the board winnowed a slate of six names, nominated by member states to five and then three.

In early April, WHO staff members, playing the roles of member state health ministers, held a dry run in the World Health Assembly hall. That is the closest they will get to the balloting process in May, when each minister will deliver a paper ballot — with no country identification — to one of six designated ballot takers. No WHO staff members will even see the ballots or be allowed in the room.

The first round needs to deliver a two-thirds majority for a candidate to win; otherwise, the voting goes to a second round in which countries must have a Plan B — no time to schmooze between rounds — then a third and possibly fourth round. Voting in secret may protect the ballot, but some WHO observers think the process precludes a much-needed open dialogue about issues and the candidates.

If there is any horse trading happening, it will surely take place during the May 22-31 meeting of the World Health Assembly here in Geneva, as in addition to electing the director-general, member states are negotiating which issues they will take to the UN General Assembly at its annual opening session in New York in September. The World Health Assembly is the first major meeting for international organizations in the lead-up to the session in New York, so alliances will be set in Switzerland.

As for the election, since every vote counts, the three finalists are doing a lot of meeting, greeting and globe hopping. If you follow their travels to detect a pattern, here is what you’ll find: Africa has largely been ignored, as the 54 African Union countries have reportedly committed to Tedros, although Dr. Nabarro was recently in South Africa. Island nations in the Caribbean and the Pacific must be befuddled at all the visions for health being offered to them by the touring candidates.

Dr. David Nabarro, 67, of Britain.

Tedros was recently in the Cook Islands, Cuba, Brazil and Thailand. Dr. Nabarro stopped in eight Latin America countries recently, as well as in Kazakhstan, Qatar, Indonesia, Japan and South Korea.

Dr. Nishtar has been visiting hospitals and clinics in Jamaica, Barbados, Chile, Argentina, Malta and elsewhere, stressing such priorities as tackling noncommunicable diseases.

The three candidates are campaigning as if the world depended on it. Two have hired public-relations firms, with Dr. Nishtar saying she hasn’t. All three tweet several times a day (see #nextdg) and have blogs, videos and websites. Each candidate has posted his or her campaign funders online, all of which are their governments. Considering the woes at the WHO, the candidates seem long on promises and short on confronting some of the most existential issues before the agency.

If Tedros, Ethiopia’s former health and foreign minister, wins, he will be the first African to lead the WHO. Tedros has also chaired boards of the Global Fund to Fight AIDS, TB and Malaria; Unaids; and Roll Back Malaria. Although members of the Ethiopian diaspora have protested outside the WHO headquarters and tweet regularly about human-rights abuses by his governing party, TPLF (Tigrayan People’s Liberation Front), a snap poll by UN diplomats conducted in early April had him winning the first round. (Ethiopia is currently an elected member of the UN Security Council and is the largest troop-contributing country to UN peacekeeping.)

Tedros says he got the most votes when the World Health Assembly executive board voted in the three finalists.

Dr. David Nabarro has the most relevant UN background, having led campaigns against H1N1 and Ebola for both the WHO and the UN. He is now the UN special adviser on the 2030 Agenda for Sustainable Development and Climate Change. Dr. Nabarro has the visible and vocal support of his government, Britain, a permanent member of the Security Council, and the slickest public-relations campaign of the three. Some inside the WHO feel he could continue to direct the reforms initiated by Dr. Chan without a steep learning curve.

Tedros Adhanom Ghebreyesus, 52, of Ethiopia.

Dr. Nishtar, a Pakistani cardiologist, is considered the civil-society candidate. She established the first federal ministry of health in Pakistan; founded Heartfile, a health care reform think tank; and chairs a WHO commission on ending childhood obesity. She talks about WHO reforms with the critical eye of an outsider who knows firsthand what stakeholders and beneficiaries expect of the organization.

The money situation

While nerves may be frayed at the WHO about the prospect of funding cuts, staff members in Geneva have been there before. Stacks of containers stand empty under a wing of the headquarters building in Geneva. An empty fountain pool in a courtyard was once filled with temporary offices when the organization was responding to an epidemic. A thousand staff members were laid off after the 2008 global financial crisis.

Both the United States and Britain have indicated plans to cut back on foreign aid, but the damage to the WHO is not yet known. “Funding for 2018-9 looks worrying,” said a WHO presentation.

Britain, having committed $412 million as of December 2016, has reportedly threatened cuts unless bigger reforms are made. At the same time, the Foreign Office is promoting Dr. Nabarro to hold the job. But a British health-department spokesperson would say only that the country “is supporting an increase to assessed contributions to WHO on this occasion in recognition of the significant changes we have called on WHO to undertake, particularly around health emergencies. This support comes with the guarantee that the UK will continue to scrutinize all money paid to WHO to ensure value for the money for our tax payers and the global community.”

The White House budget blueprint of March 2017, while proposing to cut almost 30 percent from USAID, specifically exempted GAVI, the Vaccine Alliance — the fourth-largest voluntary contributor to WHO — and the Global Fund, both heavily supported by the Gates Foundation. GAVI was started in 2000 with $750 million from the foundation. A partnership between philanthropy and the pharmaceutical industry, GAVI buys large batches of drugs for poor countries.

Silberschmidt, the WHO director of partnerships and nonstate actors, sounded guardedly confident that US funding would remain intact because of the administration’s interest in global health security, even more so under Trump, a self-described germaphobe whose “America First” budget proposal has been dubbed the “national security budget” because of its obsession with enemies. (The budget status has been delayed suddenly as the US must raise its deficit ceiling to keep the government going.)

American security priorities are not incompatible with how the administration views the value of WHO.

“Of 1,000 crises we’ve responded to, you have heard of two,” Silberschmidt said, implying that Washington has been paying attention to the WHO’s work. Earlier this year, Dr. Chan met with advisers to the US National Security Council, who signaled support for WHO’s work in global health security.

A US State Department official wrote to PassBlue that the US “values the WHO’s leadership role in advancing global efforts to detect public health threats early, especially outbreaks of infectious disease with the potential to spread beyond borders and to respond to them rapidly to ensure they are contained at their source.

“The next Director-General must set clear priorities, starting with global health security, and make the Organization more efficient and nimble, especially in carrying out its normative work.”

A participant in vaccination week in the Amazon, carried out by the Pan American Health Organization, a regional arm of the WHO. The WHO’s vaccination program has saved millions of lives but its practices have been questioned.

While more than half the US contribution comes from the USAID and Centers for Disease Control and Prevention (which also face big cuts under Trump), the rest comes from 13 different agencies, including the Department of Defense.

This level of access — to top security and defense officials, rather than just health ministries — “has been great for public health,” said Katherine Deland, the chief of staff for WHO’s Ebola response.

Médecins sans Frontières (or Doctors Without Borders), a key partner of WHO, is concerned that the organization is devoting too much of its resources to global health security.

“It’s a new trend for donor countries to stress security for their own population,” Rohit Malpani, the director of policy and analysis, said in an interview. “Global health becomes prevention in terms of outbreak response, which is about creating security for higher income countries.”

But the WHO’s 2018-19 budget proposal says “universal health coverage remains at the center of WHO’s priorities,” an indication that rank-and-file WHO member states want help at home. The funding imbalance and priority disconnect has created a “lopsided agenda and a democracy deficit,” Deland said.

Recent reforms begun by Dr. Chan are trying to address the huge imbalance between voluntary and assessed contributions and the agency’s reliance on a few big donors. As of last year, all financial contributions must be plotted into the WHO budget to be approved by the World Health Assembly. Before, only the core budget went to the Assembly for approval.

“We have a smart and clever way of dealing with the 80 percent voluntary contributions,” Silberschmidt said. “But we are bad at communicating about it.”

The WHO initiated a biennial dialogue with donors to improve the alignment of its health objectives. Recently, when Germany increased its voluntary contribution, it indicated the gift should be used where the WHO most needed it.

The six program areas of the agency now have deposit ceilings, so no one category can dominate funding. Still, some areas are seriously underfinanced, particularly noncontagious disease. HIV/AIDS is neglected, too, and the contingency fund set up to respond more quickly to crises after Ebola has received only $30 million of its $100 million target.

Emergency has become a mantra at the WHO in Geneva, and Silberschmidt said the ability of the agency to respond has improved, noting: “Ebola took four months from the first appeal to get the money. Now we have two or three incidents where the money (arrived) within 24 hours to be dispersed. Now we just need the mechanism to reload the contingency fund.”

Although all three candidates have put crisis response at the top of their priorities, the WHO has lost ground as the first-responder globally. Last year, the World Bank moved into the humanitarian crisis field as an even bigger player when it launched its Pandemic Emergency Facility, a $500 million insurance fund designed to release money quickly to curb pandemics spreading to two or more countries. The fund immediately received $50 million from Japan.

Whether the World Bank fund circumvents or competes with the WHO, officials from both institutions contend that cooperation is tight: the World Bank is exploiting its access to the private sector and insurance markets, while the WHO’s data collection will be critical to determining the trigger that springs cash in a crisis.

Dr. Chan has made headway toward the goal of universal health care, and Malpani of Médecins sans Frontières praised her for building consensus around the need for all communities to have access to medication at affordable prices.

Other experts in the global health world are far less sanguine about the pressures on the WHO.

Pushback and politics

“The real challenge will be the wave of regressively conservative politics not just in the US but in other places and among WHO donors in particular,” said Joanne Csete, a professor of clinical population and family health at Columbia University in New York.

“There will be pushback on anything related to reproductive health, migrant health, reproductive rights. . . . There will be enormous pressure for privatization of health services and promotion of big pharma and big food, big soda. . . . All these multinational companies will have newfound status. There will be pushback on climate change-related issues. The new DG [director-general] needs to be somebody who has the courage to risk his or her career to stand up to these forces.”

Several nongovernmental organizations also protest the WHO’s reliance on Bill and Melinda Gates, whose foundation trust has invested in some of the very companies they say cause bad health — such as Coca-Cola — as well as the penchant of the WHO and its partners toward vaccines as a panacea. While vaccines have saved millions of lives, concerns linger over the high price and erratic availability of vaccines and the risky research and development practices by drug companies in poor populations.

In April, the French TV channel ARTE ran a documentary blasting WHO as being “in the grip of the lobbyists.” Among the examples it cited were the WHO’s collaboration with pesticide and depleted-uranium manufacturers and the Gates Foundation.

But it appears that in an era of tight public money, that horse has already left the barn. The three candidates acknowledge the critical need for “nonstate actors.” At a roundtable in Geneva in March, Tedros, who frequently exhorted the WHO to take the “moral high ground” in such relationships, said that a code of conduct should guide work with the private sector, particularly on pharmaceutical costs and prices.

Dr. Nishtar noted at the forum that the Sustainable Development Goals gave organizations a specific mandate to engage with corporate and philanthropic actors but “with firewalls protecting the normative functions.”

Dr. Nabarro noted “our responsibility to make sure no opportunity is lost to help suffering people” and to seek opportunities through partnerships, such as campaigns that beat malaria. He said the food industry was shifting to more nutritious products, indicating private-sector initiatives could be good for women’s and children’s health. “If we get the principle right, this has to be the way to go.”

Persuading donors — governments, philanthropies or corporations — to give “nonearmarked” money will be part of the director-general’s most critical skill.

To combat trachoma, a contagious eye infection that can cause blindness, the WHO led a  campaign in Mexico that included facial hygiene instruction. The disease was eradicated there in April 2017. SEBASTIAN OLIEL/OPS-OMS

Dr. Nabarro talks about his fund-raising prowess as an important strength. But his own profiles don’t mention his most recent UN post, that of UN special envoy on Haiti and cholera. In March, The New York Times blasted the pathetic response by donors to the epidemic brought by UN peacekeepers that killed thousands of Haitians and continues to do so.

Asked by PassBlue why his Haiti role was absent from his biography, Dr. Nabarro said that the job had been one of 20 tasks assigned to him as the special envoy for the sustainable development goals; he added that much was accomplished and donations continue to come in for the Haiti cholera response. But the UN website on the project showed only $2.7 million had been raised by mid-April, toward a $400 million target.

Dr. Nishtar has outlined a “new resource mobilization strategy that will diversify the donor base and prioritize assessed rather than voluntary contributions,” possibly adding a levy to donations for the core budget.

In Ethiopia as health minister, Tedros is credited with overseeing the development of a community health care system across the country and sponsoring simple health care campaigns. But as a high-ranking official from a government that notoriously quashes dissent, who will Tedros consult when, say, an outlier group like Médecins san Frontières starts begging for funds to curb a disease outbreak?, experts ask. Will Tedros go to the nongovernmental organization or to the government minister concerned with threats to trade and tourism?

Tedros ambitiously said he wanted to increase member state dues to 51 percent of the total budget, but Dr. Chan has proposed a 3 percent increase after Germany’s proposal for a 10 percent raise was shot down by other countries. That would give the director-general a whopping $28 million more to use for unfunded mandates.

That’s “chump change,” said Steve Landry, director of multilateral partnerships at the Gates Foundation. “Member states should be embarrassed at the amount they provide. It’s totally incongruous. You’re giving an organization a task it can’t accomplish with minimal bequests.”

Gates Foundation teams work with the WHO as its regulatory and technical resources coincide well with the foundation’s interests in stemming polio and other communicable diseases. Landry’s team helps developing countries “prequalify” medications for distribution.

But though the WHO established “official relations” with the foundation in January, the foundation won’t have a vote in May. “It’s a very, very strange situation, which on balance has been a plus,” Garrett of the Council on Foreign Relations said. “But there’s no assurance that that will continue to be the case.”

It is hard to understand why these candidates want the job so badly. The $240,000 annual salary is not enormous. The financial picture is precarious. The constant travel wears out directors-general, Garrett observed, and distances them from their staff members. The WHO is positioned at a major crossroads, while health crises abound and donor countries retrench. Perhaps the three are risk-takers who have put representing the well-being of all people at the top of their bucket list.

“WHO is an important platform,” Csete of Columbia University said. “And at various times in history, it’s been an enormously respected and sought-after one.”

Deland, chief of staff for WHO’s Ebola response, said: “That is what WHO does. It provides world-class advice with the best network in the world.”

Dr. Chan weathered her share of such storms. Through a series of webposts that began on April 13, she has been wrapping up her tenure from 2007 to 2017, writing: “Together we have made tremendous progress. Health and life expectancy have improved nearly everywhere. Millions of lives have been saved. The number of people dying from malaria and HIV has been cut in half. WHO efforts to stop TB saved 49 million lives since the start of this century. In 2015, the number of child deaths dropped below 6 million for the first time, a 50% decrease in annual deaths since 1990. Every day 19000 fewer children die. We are able to count these numbers because of the culture of measurement and accountability instilled in WHO.

“In a world facing considerable uncertainty, international health development is a unifying — and uplifting — force for the good of humanity.”

The next director-general takes office on July 1, 2017.

This article was made possible through a grant from the Carnegie Corporation of New York and individual donors.

Babatunde Osotimehin, who led the United Nations Population Fund from 2011 until his death on June 4, 2017, visiting Niger.

The death on June 4 of Babatunde Osotimehin, executive director of the United Nations Population Fund, UNFPA, and a Nigerian, was not only a personal tragedy and a shock to the staff of the fund but also another blow for an agency that had recently lost all its United States financial support.

Osotimehin, a physician, died at his home in New York, apparently from a heart condition, said a UN spokesman. Osotimehin was in his second term as the fourth director of the Population Fund, which was founded in 1969 largely through the impetus of the US. Originally named the UN Fund for Population Activities, the name was changed in 1987, reflecting a broader mandate in maternal and family health.

Before joining the UN with the rank of under secretary-general, Osotimehin was Nigeria’s minister of health and earlier director-general of Nigeria’s National Agency for the Control of AIDS.

In January, within days of his inauguration, President Donald Trump, pressured by an anti-abortion lobby in the US, gave in to political conservatives who have consistently and falsely accused the UN Population Fund, the world’s largest provider of family planning and maternal health care, of abetting abortion in China. The Fund had previously lost its US financing under the George W. Bush administration, but contributions were restored and enhanced under President Obama.

The fund’s global conferences on population and development, held every decade since the 1970s, reached their high-profile peak in a stormy session in Cairo in 1994, led by a former executive director, Nafis Sadik, which produced a groundbreaking declaration of a woman’s right to make her own reproductive choices.

Osotimehin continued the Fund’s sometimes controversial campaigns — against female genital mutilation and child marriage and stopping violence against women — although his approach was often not very vocal. Critics have said that to some extent his low-key approach dimmed the image and influence of the agency as a backlash grew in various parts of the world against the Fund’s emphasis on rights.

He was the oldest of eight children, four boys and four girls. His father was a schoolteacher and his mother, as Osotimehim said in a 2013 interview, was an entrepreneur who sourced organic foods in their small town of Ijebu-Igbo in southwest Nigeria.

“Somebody wanted mangoes?” Osotimehin said about his mother, Morenike. “She’d tell you where to get the best and organize that you got them.” The household also consisted of cousins and nephews; often there were 15 people around. “For me, that was the happiest time in my life.”

His mother, he said, insisted her children “show progress in school, develop our skills and go to college.” Osotimehin fulfilled his mother’s wishes, earning a medical degree at the University of Ibadan, Nigeria, in 1972 and a doctorate in medicine from the University of Birmingham in Britain in 1979. He was appointed professor at the University of Ibadan in 1980 and headed the department of clinical pathology before being elected provost of the College of Medicine in 1990.

Following the news of his death, Osotimehin was applauded as a strong and helpful colleague by numerous groups working in women’s health and rights worldwide.

The director general of the London-based International Planned Parenthood Federation, Tewodros Melesse, said in a statement on June 5: “Even before he became UNFPA executive director, Dr Babatunde had shown how dedicated and committed he was to the struggle for improved sexual and reproductive health for all people. . . . During his leadership, UNFPA and IPPF worked side by side to reach the poorest and those most in need with sustainable sexual and reproductive health care, as well as campaigning together to improve the lives of women, girls and those most likely to be stigmatized and marginalized by society.”

The Population Fund said in its statement about Osotimehin’s death: “This is a devastating loss for UNFPA and for the people, especially women, girls and youth, he dedicated his life to serving. UNFPA expresses its deep sympathy to his family and prays that they have the fortitude to bear this great loss.”

Osotimehin seemed to have landed at the Fund through his mother’s “guiding spirit,” as he called it, saying in the 2013 interview: “She also believed she could choose what she wanted to do. She knew that lives had to be saved and women had to be empowered.”

Achim Steiner, a German-Brazilian, ran the United Nations Environment Program from 2009 to 2016. He was recently named to head the UN Development Program. Here, he rides an electric bike at the UN Environment Program base in Nairobi.

BERLIN — It is a widely held view in political circles here that Germany has not been adequately represented in the United Nations, apart from its relatively frequent elected membership to the Security Council, which Germany has held five times and which last year announced its candidacy for a sixth term for 2019-2020.

To be more precise: the criticism in Germany concerning fair representation refers to leading positions in UN funds, programs, specialized agencies and the Secretariat. There is some truth to the view: Germany has held the leadership position in the UN Environment Program, or UNEP, only twice: Klaus Topfer, from 1998 to 2007, and Achim Steiner, from 2009 to 2016. It has held no top position in a UN specialized agency.

As to the latter, at the UN in New York, only four Germans have led Secretariat departments as under secretaries-general: Helmut Debatin (Management, 1979-1981); Carl-August Fleischhauer (Office of Legal Affairs, 1983-1994); Karl-Theodor Paschke (Office of Internal Oversight Services, 1994-1999); and Angela Kane (Management and Office for Disarmament, respectively, 2008-2015). All four Germans acted in managerial functions and not in politically influential positions.

So there was quite some relief in Berlin when UN Secretary-General António Guterres named Achim Steiner as the new administrator of the UN Development Program, to succeed Helen Clark of New Zealand in June. Steiner, who has German and Brazilian nationality, is considered a good choice in UN circles because he achieved remarkable successes as head of the UN Environment Program, from 2006 to 2016, strengthening, above all, the financial basis of the program.

In Germany, the sense of satisfaction in political arenas was pronounced after Steiner’s appointment as well as the naming of Ursula Mueller of Germany as assistant secretary-general for humanitarian affairs.

Nevertheless, Germany has not been consistently successful in recent years in placing candidates in top UN jobs:

• In 2011, Angela Kane, having served the UN in many functions for more than 30 years, applied as an incumbent under secretary-general for management for the post of director-general of the UN Office at Geneva (UNOG), but without political support from Berlin. Secretary-General Ban Ki-moon ignored her brilliant qualities as a candidate and appointed instead a former Kazakh prime minister, Kassymschomart Tokajew, who had no UN experience but was obviously an appointment to please the permanent Security Council members Russia and China.
• In 2015, Steiner, the UN Environment Program head, ran for the post of UN High Commissioner for Refugees. Once more, Ban decided against the German candidate and appointed an Italian, Filippo Grandi.
• The same thing happened in 2015 to the candidacy of a longstanding UN top official, Franz Baumann, a German who was running for deputy high commissioner for human rights. But Ban picked Flavia Pansieri of Italy instead, whose reputation was clouded amid revelations related to allegations of sex abuse by French peacekeepers in the Central African Republic. The job is now held by an Australian, Kate Gilmore.
• Angela Kane became a candidate again in 2016, after she had been urged by Ban in March 2015 to resign from her post as head of the Office of Disarmament Affairs after only three years to make space for Ban’s Korean colleague in the Secretariat, Kim Won-soo. Kane was then presented as the official German candidate for the post of the executive director of the World Food Program in addition to another official German candidate, Martin Kobler, a well-proven mediator in many UN missions and now special envoy of the UN support mission in Libya (Unsmil). Both candidacies were unsuccessful because of strong pressure from Nikki Haley, the United States ambassador to the UN, to give the job to a fellow American, David Beasley. Guterres assigned the post to Beasley in March 2017. Again, the interests of a big power prevailed over the excellent candidacies of two German UN insiders, with the US keeping the post traditionally under its control.
• Also in 2016, Jochen Flasbarth, the German candidate to succeed Steiner as head of the UN Environment Program and a well-respected international negotiator, lost out to Erik Solheim of Norway.

This series of candidacies unable to obtain these posts has been particularly disappointing for Germany, as it still is markedly underrepresented in high-level positions in the UN. At the uppermost level, Germany is represented only by Kobler (in rank equivalent to an under secretary-general, or USG); Mueller (assistant secretary-general, or ASG); and now Steiner, with the rank of under secretary-general.

To sum up: If one takes Germany’s role as the fourth-largest payer to the regular budget of the UN into account (contributing 6.39 percent, after the US with 22 percent, Japan with 9.68 percent and China with 7.92 percent), the persistent lack of adequate representation of Germany in leading UN positions cannot be considered politically fair.

Other member countries contributing less financially are far-better represented, according to the current list of senior officials issued in April 2017 by the UN Secretariat:

• France, fifth-largest payer (4.86 percent), has five UN officials in under-secretary-general level positions and three in assistant-secretary-general level positions.

• Britain, sixth-largest payer (4.46 percent), has six UN officials in under-secretary-general level positions and nine in assistant-secretary-general level positions.

• Japan (9.68 percent) and China (7.92 percent) are significantly underrepresented: China has one official on each level and Japan has two under secretaries-general and one assistant secretary-general.

• Russia, the eighth-largest payer (3.088 percent), has also only one official on each level, comparable to China.

Notwithstanding the differences in quantity, the five permament members of the Security Council (Britain, China, France, Russia and the US) make effective use of their political weight to gain important top positions in the UN Secretariat: an American is leading the Department of Political Affairs; Britain heads the Office of Coordination for Humanitarian Affairs; France has the Department of Peacekeeping Operations; Russia, the director-general of the UN Office in Vienna, functioning also as the head of the UN Office on Drugs and Crime; and China provides the under secretary-general for Economic and Social Affairs.

It is not surprising that Angela Kane criticized the unsatisfactory situation for Germany in a public hearing of the Subcommittee on United Nations Affairs of the Foreign Affairs Committee of the German Bundestag in June 2015, saying, “With regard to UN top positions, Germany is miserably represented.”

Kane noted at the hearing that she thought the main reason for the low numbers was the reserved attitude of German politicians toward the UN, saying, “Other states use a rather robust and forceful approach in UN personnel policy.”

The lessons to be learned from the lack of strong support from Germany are evident: German politicians should understand the importance of having excellent experts and negotiators in the UN, back their candidates for top jobs robustly and accompany that effort with financial commitments, as this has proven to be helpful in competition for these UN jobs.

On the other hand, the UN secretary-general and the General Assembly should learn from the examples of Kane and Steiner that it is worthwhile to choose the best woman or man for a top position and not to follow the questionable habit of giving a certain UN post traditionally to a certain nation.

This article was updated. 

Nikki Haley and the Egyptian ambassador to the UN, Amr Aboulatta, in the Security Council. Haley told Congress recently that Trump’s proposed budget for the UN put the world body “on notice.” RICK BAJORNAS/UN PHOTO

Five months into her stint as United States ambassador to the United Nations, Nikki Haley faced two days of often-sharp questioning on June 27 and 28 by influential panels of the United States Congress. They demanded justification for the Trump administration’s decision to slash funding to the United Nations, particularly cuts to the UN Population Fund, Unicef, UN Women and the World Food Program.

Concerns were also raised about the wisdom of reducing the US budget contributions to peacekeeping from 27 percent to 25 percent (which cannot be done unilaterally without incurring arrears) and by squeezing peacekeeping missions around the world. Haley was proud to note that funds for the mission in Haiti were being cut by $150 million, though Secretary-General António Guterres just named Josette Sheeran, special envoy on cholera in Haiti, the poorest country in the Western Hemisphere. Cuts to US contributions to the International Atomic Energy Agency in an era of nuclear proliferations were also questioned.

Haley also proudly told Congressional members that the US got the UN General Assembly budget committee this month to reduce the annual peacekeeping budget. In fact, the US aimed for $1 billion in cuts but agreed to about half that amount, for a total yearly budget of $7.3 billion.

Paradoxically in her testimony in Congress, Haley bemoaned the lack of equipment for peacekeeping troops (the mission in Mali desperately needs armored tanks), which could be financed through a more generous UN budget and save lives.

The tone of questions asked to Haley by Congressional members may suggest that Trump’s 2018 budget will not get significant legislative support on UN-related issues, yet there remains a hard core of Republican legislators who — not always clear on facts or context on how the organization works — are dismissive and insulting. Among them and other groups, a strong pro-Israeli lobby continues to function and may have been strengthened by Trump’s team.

Haley acknowledged pressure from Israel — calling it “support” — that led to the US forcing Guterres, the secretary-general, to reverse the appointment in February of Salam Fayyad, a former Palestinian prime minister, as the UN’s special representative for Libya. Fayyad’s appointment apparently was not initially opposed by Haley. Asked by a member of Congress about the last-minute about-face in the US on Fayyad, Haley said that because Palestine was not recognized as a country by the US, a Palestinian should not be given an official UN post.

In this case, she said, appointing him would add to the UN’s “imbalance” against Israel. She would not say clearly whether Israel forced the change in the original US position or whether a Palestinian could ever be approved for a UN post.

On her first day testifying before Congress, Haley was questioned by a House of Representatives appropriations subcommittee dealing with funds for international organizations; on the second day, she faced the full House committee on foreign affairs. A consummate politician, Haley performed well, skirting some issues, although generally showing unwavering support for the Trump team and the president himself.

“We are on the same page,” Haley said of Trump, who seems to approve of her tough talk in the international arena and his voice at the UN. “I don’t go rogue on the president.”

Yet, she added later that “this administration does not tell me what to say or not to say.”

In an interesting interlude amid the questioning by appropriations committee members, Haley revealed that the most recent threat to Syria’s president Bashar al-Assad and his backers, Russia and Iran, should another Syrian chemical weapons attack occurred, was just a threat by the US, with no action planned.

The goal, she said, was “to send a message” not only to Syria but also to Russia and Iran to get them to “back off.”

On the zeroing out of US funds for Unicef from the proposed 2018 federal budget, about which members on both committees voiced a range of reactions — from disbelief and disappointment to shock and outrage — Haley breezily replied to one questioner that the “starting point” of the budget was to build up the military and look for cuts everywhere else.

She did not react when Rep. Gerry Connolly, a Democrat from Virginia, asked whether the world’s children — through slashing Unicef — should have to pay for the US military buildup, saying it was “not a proud value that Americans would uphold.”

Members of Congress, many of them Democrats shut out of policymaking in a House of Representatives controlled by the Republican party, also wanted to know why the US appeared to have an incoherent foreign policy. They noted conflicting pronouncements in President Trump’s tweets and public flip-flops; measured statements by Secretary of State Rex Tillerson; and declarations by Haley that seemed to be her own opinion at times.

Putting it mildly, the US has become “unpredictable,” a legislator said.

Pressed to describe her relations with her bosses in Washington, Haley revealed to the foreign affairs committee that she rarely talked with Trump or Tillerson and had no information on the unusual number of vacancies in the US State Department. She said that her closest relationship was with the national security adviser, H.R. McMaster; the defense secretary, James Mattis, with whom she spoke on issues concerning the UN; and others in the president’s cabinet, of which she is a member.

“We work as a team,” she said, adding that there was “a very organized process in place.”

On Russia, Haley stuck to her strong objections to the invasion of Crimea and Moscow’s incursions into eastern Ukraine, and accepted that Russia meddled in the 2016 US election. She insisted, however, that Trump was not involved in colluding with the election interference. Asked whether she had discussed with Trump the Russian involvement in the election, possibly at the direction or President Vladimir Putin, Haley said that topic had not come up because it was not a UN matter.

Haley faced many questions on the rationale for the total defunding by the Trump administration of the UN Population Fund, or UNFPA. The most persistent questioners came from Democrats, but they were not alone. Haley responded that there was nothing she could do about the full loss of funds from the US to UNFPA since it had been done by presidential order. She insisted that the money saved, about $70 million by current calculations, would go to similar US aid programs.

Those programs, however, strictly bar US funding for any international organization or NGO that assists or even counsels on abortion. Reflecting her lack of interest about the loss of money to UNFPA, she was asked how maternal health care was being replaced by the UN agency in the Zaatari refugee camp in Jordan, which she just visited. Although she admitted she didn’t know, she said the next day in Congress “I always just meet with women” when she had visited the refugee camps in Jordan and Turkey.

The Trump administration (and the George W. Bush administration) used debunked reports that the Population Fund’s work in China supported forced abortions there to stop financing the agency. Haley repeated the claim, but told the appropriations subcommittee that the UNFPA was “associated” with a “company” in China that was guilty of involuntary “sterilization.” She did not repeat that formulation in the foreign affairs hearings, but Lois Frankel, a Democrat from Florida, called the China reason a “totally phony excuse.”

“A lot of women are going to suffer,” said Ami Bera, a Democrat from California and medical doctor, said about the cuts to the Population Fund.

Much of the hearings were consumed by repeated questions and criticisms of the Human Rights Council. Haley repeated what she said in her confirmation hearing in January about the Council needing to be “fixed.” She has never said plainly that the US is considering withdrawing from the 47-nation body. But in Geneva in June, Haley, saying she had come to see the Council firsthand, made a brief appearance (about three minutes) in the chamber to announce her presence.

Later that day in a speech to the Graduate Institute of Geneva, she warned that the US could “go outside” the Council to protect human rights if two nonnegotiable conditions were not met.

In that speech, Haley demanded that the Council change its election procedures (which would have to be done by the General Assembly) to “keep the worst human rights abusers from obtaining seats on the Council.” That would mean open elections of Council members, who are now chosen regionally by consensus, or horse-trading.

“As it stands, elections for membership to the Council are over before the voting even begins,” she said. “No competition means no scrutiny of candidates’ human rights records. We must change the elections so countries are forced to make the case for membership based on their records, not on their promises.”

Her second demand was that a Council agenda provision — known as Item 7 — which perennially singles out Israel for condemnation, “must be removed.” That command has garnered wide bipartisan support in the US, and American diplomats have been successful in recent years in reducing the number of obsessive resolutions on this issue, which will not be open to debate again until 2020. In Congress, Haley pointed to Egypt, Pakistan and Saudi Arabia as providing the “hard core support” for Item 7.

Haley had no problem defending Trump’s decision to quit the Paris Agreement on climate change. “We are not going to throw climate out the window,” she said, adding: “What the president did was in the best interest of businesses and the best interest of our country.”

To which Connolly, the representative from Virginia, proclaimed that Trump’s decision put the US in the same boat as Nicaragua and Syria.

Smoking rates in many countries have been dropping while in other countries, prevalence remains flat. In Estonia, above, the rates for men and women are above average compared with other high-income countries. The country has made gains in raising taxes on tobacco, but it has not passed laws to create comprehensive smoke-free spaces. CREATIVE COMMONS

More than half the world’s population — 63 percent — is covered by one or more comprehensive tobacco control measures. In the past 10 years alone, that number has more than doubled, says a new report from the World Health Organization on the “global tobacco epidemic.”

An international push for policies, like strong graphic warnings, a ban on tobacco advertising and smoke-free public spaces, has touched the lives of 4.7 billion people.

Such policies have saved millions of lives, but millions of more people remain in danger, say WHO experts, as tobacco kills seven million people a year. Male smokers living in middle-income countries are by far the largest group of smokers in the world, numbering 765 million, or 68 percent of all smokers.

Around half of the world’s female smokers (85 million) live in high-income countries, and women’s average overall smoking rates have decreased from 8 percent globally in 2007 to 6 percent in 2015.

Men’s average overall smoking rates are declining slowly, from 39 percent globally in 2007 to 35 percent in 2015. The biggest drops are occurring in high-income countries.

“The good news is, tobacco prevalence is going down,” Rosa Sandoval, a regional adviser tobacco control for the WHO, said in an interview. “The bad news is, it is not going down as fast as we would like to see.”

Tobacco advertising is identified as one of the biggest hindrances to progress in use of tobacco. According to the report, major companies “spend tens of billions of US dollars worldwide each year” on promotions to increase sales and boost profits. Health officials say companies use targeted marketing to encourage nonsmokers to start.

The report identifies women and young children in low- and middle-income countries as most vulnerable to these business strategies.

“You might imagine that it would be rare for an adult to be smoking a bubblegum flavored cigarette,” said Dr. Kelly Henning, who leads the Bloomberg Philanthropies Public Health program, which includes a nearly $1 billion campaign to curb the tobacco epidemic in low- and middle-income countries. “That product is almost surely targeted towards children and young adults to get more and more of those age groups hooked on tobacco.”

Sandoval said that WHO hoped to see the prevalence of tobacco drop 30 percent from 2010 to 2025. However, prevalence is currently decreasing at a rate of only 4 percent every five years, so the goal is far out of reach. That is not to say that countries have done a poor job fighting what advocates call the tobacco epidemic so far.

The report defines tobacco as cigarettes and other forms of smoked tobacco (e.g. cigars, pipe, bidis, water pipes); and smokeless tobacco products, such as chewing tobacco and snuff.

According to the report, the MPOWER initiative, a WHO program to reduce tobacco demand, has not only saved millions of lives but also hundreds of billions of dollars since it began in 2008. MPOWER works on six strategies: “Monitor tobacco use and prevention policies; protect people from tobacco smoke; offer help to quit tobacco use; warn people about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; and raise taxes on tobacco.”

The report notes that eight countries have fully implemented at least four of the MPOWER measures: Brazil, Britain, Iran, Ireland, Madagascar, Malta, Panama and Turkey. Five of the countries are classified as low- or middle-income. Sandoval said these gains have showed a key advantage of the MPOWER’s ability in fighting the influence of tobacco companies. But 57 countries have yet to adopt a single MPOWER measure.

“The good news is, you do not need to be a rich country to implement these policies,” Sandoval said. “In the new WHO report, you will see how low- and middle-income countries have implemented successful policies to curb the tobacco epidemic in the region of the Americas.”

In the United States, for example, cigarette smoking has dropped to historic lows, yet tobacco use remains the leading cause of preventable disease and death in the country, killing more than 480,000 people a year. The Food and Drug Administration recently announced a new program to tackle the addictive nature of tobacco through tighter regulation of nicotine.

Sandoval deals specifically with the Americas in her work, but the report shows that its findings apply globally as well. In addition to MPOWER’s success, Sandoval said that 18 countries have banned smoking entirely in public places and workspaces. She said that this policy not only discouraged current smokers but also potential smokers.

“It communicates a strong message to society that this is a product that harms your health, so if you want to smoke it, you have to do it outside,” she said. “You cannot expose other people to secondhand smoke.”

Sandoval said that tobacco taxes have proven to be the most cost-effective measure under the WHO Framework Convention on Tobacco Control to cut consumption and encourage users to quit. Nevertheless, the report demonstrates that taxes are the tool least adopted by UN member states.

One problem the report identifies is that “tobacco excise tax structures in many countries are quite complex, with different (tiered) taxes that are applied to the same product based on sometimes minor differences in product characteristics. Tobacco companies take whatever actions they can to keep taxes low.”

The report recommends a single, specific high tax on all tobacco products that adjusts with the economy’s growth. Tobacco taxes, it says, are especially important because increased government revenues can be used to finance treatment and prevention of noncommunicable diseases nationally.

The report says that tobacco is a “leading common risk factor” for noncommunicable diseases, which are responsible for around 70 percent of deaths globally each year.

For most low- and middle-income countries, however, a uniform tobacco tax is a distant reality. The report says that only 11 countries, or 8 percent of low- and middle-income countries, levy taxes at rates in accordance with WHO recommendations. Sandoval said these countries also suffer socially and economically because of the structure of the tobacco industry.

“Many of the children that are part of families growing tobacco are working and studying at the same time, and a high percentage of these children are not going to school,” Sandoval said.

If children are focusing less on school and more on work, she said their families and their countries alike suffer in the long run. She also stressed the link between tobacco-production and poverty.

“This is a product that is associated [with] diseases that require large budgets to be cured or to be taken care of, and usually people live with these diseases or conditions for a long time,” she said. “So, this is a distress not only on the families but also the public budget in the health sector.”