World Health Assembly 2018 Report

IFMSA report on WHO’s

71 World Health Assembly st

IFMSA Vice President for Activities Hana Luèev vpa@ifmsa.org Vice President for Finance Amela Hamidoviæ vpf@ifmsa.org Vice President for Members Satria Nur Sya’ban vpm@ifmsa.org Vice President for External Affairs Batool Al-Wahdani vpe@ifmsa.org Vice President for Capacity Building Frida Vizcaino Rios vpcb@ifmsa.org

The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organisation representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains 137 National Member Organisations from 127 countries across six continents, representing a network of 1.3 million medical students.

IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so as to shape a sustainable and healthy future.

IFMSA is recognised as a nongovernmental organisation within the United Nations’ system and the World Health Organization, and works in collaboration with the World Medical Association.

Publisher International Federation of Medical Students’ Associations (IFMSA)

This is an IFMSA Publication

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International Secretariat: c/o Academic Medical Center Meibergdreef 15 1105AZ

© 2018 - Only portions of this publication may be reproduced for non political and non profit purposes, provided mentioning the source.

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This publication contains the collective views of different contributors, the opinions expressed in this publication are those of the authors and do not necessarily reflect the position of IFMSA.

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Contents

Welcome Message Page 3

Message from the Head of Delegation Page 4

Introduction to the WHO and the WHA Page 5

The IFMSA Delegation to the WHA Page 7

Visibility and Social Media Page 9

Official Interventions Page 10

Highlights from WHA71

www.ifmsa.org

Page 11

Stream Reports Page 18

Side Events Co-Hosted by IFMSA Page 22

Photo Credits: Cover Copyright Š 2015 - WHO/Photo Library Page 5, 9, 14, 15, 16, 17, 19, 22 - WHO/A. Tardy Page 10, 11 - WHO/L. Cipriani Additional pictures supplied by IFMSA delegates

Welcome Message Batool Al-Wahdani IFMSA Vice-President for External Affairs 2017 - 2018 vpe@ifmsa.org

Dear all, Youth, being one of the biggest demographics on earth, are undoubtedly an agent of positive change in the world. They not only are the future leaders, but also the current influencers and innovators. IFMSA believes in meaningful youth participation, which is one of our main priorities as a global student organisation. We strive to participate actively in decision making processes and events regionally and globally.

The World Health Assembly (WHA) serves as an important platform of decision making and advocacy in global health.

Policies, guidelines, reports and plans are discussed, negotiated and adopted in different sessions during the World Health Assembly. IFMSA ensures that youth have a voice in all these discussions, and actively advocate for what they believe in.

IFMSA’s delegation to the World Health Assembly served as a great example of youth potential and ability to contribute to global processes. In addition, it showed the importance of interprofessional collaboration, by having participants from different backgrounds. The delegates prepared for their participation months in advance, by collaborating together in drafting statements and policy briefs, and gaining the knowledge and skills they need through the Youth Pre-World Health Assembly Workshop. Throughout the assembly, the delegates participated in discussions, presented statements, spoke to member states and attended several side events in which they shared their ideas and thoughts.

It’s a great honor to witness IFMSA’s successful participation in the 71st World Health Assembly. Not only did IFMSA make sure to voice our members’ opinions on the global health topics addressed in the meeting through several statements in main

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sessions, but also was able to ensure our active engagement in several side events. IFMSA participated in the main panel of the Primary Healthcare Technical Briefing organised by the World Health Organization. We presented our opinions about the role young healthcare professionals play in Primary Healthcare. In addition, IFMSA co-hosted a side event with UNRWA about the health of Palestinians and Palestinians Refugees. IFMSA officially signed the Global Compact on Universal Health Coverage and joined UHC2030 partnership.

And, as meaningful youth participation is a vital guiding principle for us, we participated actively and co-hosted the Youth Town Hall Meeting, to discuss the active youth engagement with the WHO. We also reaffirmed our commitment to be active civil society members. All of these achievements were the results of continuous work and efforts during the term, which translated to reality in the World Health Assembly.

The 71st World Health Assembly has been a great successful experience for our delegates, and a platform where IFMSA was able to seek new partnerships and collaborations. It also empowered us to continue our active voluntary work in local, national and international level, serving our communities and the people in need. The organising committee has done an amazing job preparing the delegates. I’m very proud of and thankful for all the delegates who represented IFMSA greatly in the meeting, our external achievements are continuing because of your hard work!

Message from the Head of Delegation Amine Lotfi IFMSA Liaison Officer to the WHO 2017 - 2018 lwho@ifmsa.org

Dear global health enthusiasts from all over the world, This document summarises the work achieved by the IFMSA delegation to the 71st World Health Assembly, which took place in the Palais des Nations in Geneva, Switzerland, from the 21st until the 26th of May 2018.

The Assembly, which is WHO’s highest decision-making body, setting out the Organization’s policy and approving its budget, opened this year with an ambitious agenda for change that aims to save 29 million lives by 2023. It was attended by nearly 4000 delegates from WHO’s 194 Member States and partner organisations.

Delegates discussed a range of global health issues, including the 13th General Program of Work, which is WHO’s 5-year strategic plan to help countries meet the health targets of the Sustainable Development Goals (SDGs). Other topics that were covered at this year’s World Health Assembly included WHO’s work in health emergencies, polio, physical activity, vaccines, the global snakebite burden and rheumatic heart disease. The WHO General Program of Work, designed to address these challenges and accelerate progress towards the SDGs, is the result of 12 months of intensive discussion with countries, experts and partners, and centers on the “triple billion” targets: 1 billion more people benefitting from universal health coverage, 1 billion more people better protected from health emergencies and 1 billion more people enjoying better health and well-being.

“This is a pivotal health Assembly. On the occasion of WHO’s 70th anniversary, we are celebrating 7 decades of public health progress that have added 25 years to global life expectancy, saved millions of children’s lives, and made huge inroads into eradicating deadly diseases such as smallpox and, soon, polio,” said Dr Tedros.

This Health Assembly opened against the backdrop of a new

outbreak of Ebola in central Africa, a stark reminder that global health risks can erupt at any time and that fragile health systems in any country pose a risk for the rest of the world.

Moreover, the World Health Statistics 2018, WHO’s annual snapshot of the state of the world’s health, highlights that while remarkable progress towards the SDGs has been made in some areas, in other areas progress has stalled and the gains that have been made could easily be lost. The latest data available shows that less than half the people in the world today get all of the health services they need.

Each year, IFMSA has a unique opportunity to send a large delegation of youth advocates to the World Health Assembly.

Together, our 54 youth delegates from all around the world coming from backgrounds as varied as medicine, dentistry, veterinary sciences and public health helped raise the youth voices on crucial global health issues. We’re extremely proud of the successes achieved by IFMSA this year in terms of meaningful youth participation. We have been given a voice in different high-level panels organized by WHO. It was also the occasion to meet and strengthen our partnership with some of the global health actors we work closely with.

My utmost gratitude goes out to all of those who contributed to the success of our participation at the World Health Assembly: our National Member Organizations that helped shape the policy documents and priorities of our Federation, our members who contributed online via social media, the Team of Officials and the Youth Pre-World Health Assembly Workshop Organizing Committee and the partners and sponsors who helped make the event a success, and last but not least, the amazing members of the IFMSA delegation.

We as a Federation are committed to continue contributing to achieving the health goals set during this World Health Assembly, and to continue raising the voices of medical students worldwide.

Introduction to the WHO and the WHA The World Health Organization The WHO was created when its Constitution came into force on the 7th of April 1948, a date now celebrated every year as “World Health Day.” More than 7000 people from over 150 countries work for WHO across national and regional offices, as well as its headquarters in Geneva.

The WHO remains committed to the principles that are set out in the preamble of its Constitution: • Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

• The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.

• The achievement of any State in the promotion and protection of health is of value to all.

• Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger.

• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.

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• The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.

• Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.

• Governments have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures.

The WHO is the directing and coordinating authority on international health within the United Nations’ system. WHO does this through: • Providing leadership on matters critical to health and engaging in partnerships where joint action is needed; • Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; • Setting norms and standards and promoting and monitoring their implementation; • Articulating ethical and evidence-based policy options; • Providing technical support, catalysing change, and building sustainable institutional capacity; • Monitoring the health situation and assessing health trends.

Source: http://www.who.int/about/mission/en/ Accessed on June 18th, 2017.

Introduction to the WHO and the WHA IFMSA and WHO The International Federation of Medical Students’ Associations (IFMSA) is one the largest international student organizations and aims to serve medical students all over the world.

Currently, the IFMSA represents 1.3 million medical students through its 137 national member organizations. Its vision is a world in which all medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally.

The IFMSA is an independent, non-political organization, founded in 1951, and is officially recognized as a NonGovernmental Organization (NGO) within the United Nations’ and recognized by the World Health Organization as the International Forum for medical students.

The IFMSA aims to offer medical students a comprehensive introduction to global health issues. This is done through the exchanges, with more than 13.000 exchanges per year the largest student-run exchange program in the world, and work in the fields of medical education, reproductive health, human rights and public health.

The International Federation of Medical Students' Associations was one of the numerous international student organizations set up directly after the end of the Second World War. The first meeting that saw the establishment of the Federation was held in Copenhagen, Denmark in May 1951. The growth of IFMSA through the years has been remarkable. Starting from the exclusively European founding organizations the Federation has expanded to include more than 100 members from all over the world in the sixty years of our organization.

Official relations with WHO started back in 1969, when the collaboration resulted in the organization of a symposium on "Programed Learning in Medical Education", as well as immunology and tropical medicine programs. In the following years, IFMSA and WHO collaborated in the organization of a number of workshops and training programs. IFMSA has been collaborating with UNESCO since 1971.

IFMSA collaborates with the World Health Organization through various departments, programs and projects.

The IFMSA has a Liaison Officer to the World Health Organization (LO-WHO) who is responsible for fostering the established partnership between IFMSA and WHO. This is done by bringing medical students to WHO (through internships, delegations to meetings, and co-organization of events) and by bringing WHO to medical students (through general updates and communication, and inviting externals to IFMSA events). The LO-WHO is also involved in organizing Youth Pre World Health Assembly (Pre-WHA), and seeks to establish internships at WHO’s regional offices, so to allow medical students to discover WHO in a more accessible and affordable way. The LOWHO can be contacted through lwho@ifmsa.org.

The World Health Assembly (WHA) The 71st session of the World Health Assembly (WHA) took place in the Palais des nations, Geneva, 21–26 May 2018.

The World Health Assembly is the decision-making body of World Health Organization, and is attended by delegations from all WHO Member States as well as non-State actors and focuses on a specific health agenda prepared by the Executive Board of the World Health Organization. Its main functions are to determine the policies of the Organization, supervise financial policies, and review and approve the proposed program budget. The World Health Assembly is held annually in Geneva, Switzerland.

More than 4000 delegates from WHO’s 194 Member States – including a large proportion of the world’s health ministers - attended the Health Assembly. They have discussed resolutions and decisions on Air Pollution, global shortages of Medicines, the Health Workforce, Childhood Obesity, Road Safety Non-Communicable Diseases, and the election of the next Director-General, amongst other topics.

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The IFMSA Delegation to the WHA The International Federation of Medical Students’ Associations attended the World Health Assembly with a delegation of 54 young delegates from around XX countries and a variety of backgrounds including medical, dentistry, pharmacy, veterinary sciences and public health. The Delegation included:

Mr Lotfi Amine Ms Batool Ahmad Al-wahdani Ms Charlotte Anne O’Leary Mr Dominic Schmid Ms Camille Pelletier Vernooy Ms Elizabeth Tolulope Peters Mr Jérémy Glasner Mr Patrick Walker Mr Carles Pericas Mr Jonne Juntura Ms Sanne de Wit Ms Hana Lučev Ms Anshruta Raodeo Mr Pablo Estrella Porter Mr Marian Sedlak Ms Alja Špicar Ms Lara Rosa Scherer Mr Li Han Wong Mr Wong Gabriel Chun Hei Ms Michelle Houde Mr Jorge Manuel Félix Cardoso Ms Navkiran Kaur Bains

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Ms Lam Tin Kei Mr Christos Samaras Mr Daniel D’Hotman de Villiers Ms Paula Pereira de Souza Reges Mr Adonis Wazir Ms Rose Adjei-Bempah Ms Eliza Kluckow Ms Ave Põld Ms Soha Ahmed Ibrahim Mr Kareem Waleed Makkawi Ms Balkiss Abdelmoula Ms Baladi Soukaina Ms Sahasrabudhe Saniya Sameer Ms Danielle Wiesner Ms Ayilkin Çelik Ms Eman Suliman Ms Sarah Ann Marnin Ms Rannei Hosar Mr Elliot Chong Yeung Ms Saana Mäenpää Ms Isabel Jiménez Camps Ms Sara Esameldin Adam Nagi

Mr Isaac Florence Ms Gemma Louise Whyatt Ms Rosemary Herrington Mr Tarek Turk Ms Naomi van Veen Mr Bou Zerdan Maroun Mr Aamr Hammani Ms Emma Joanna Lengle Mr Ankit Raj Mr Souvik Pyne

The IFMSA Delegation to the WHA

Visibility and Social Media Social Media and Public Relations Coordinator: Ms. Elizabeth Peters IFMSA Vice-President for Activities: Ms. Hana Luèev

Social Media and Advocacy:

Visibility of IFMSA at the preWHA and WHA70:

For the past few years, the IFMSA has sent a large delegation

All participants were encouraged to use #yWHA71 and #WHA71 throughout the duration of the preWHA and WHA event. In Summary, IFMSA as a student group dominated the hashtag #yWHA71 according to Brand24, a renown social media analytical tool, we produced a whopping 1281 tweets, ensuring high visibility of our activity at the PreWHA. IFMSA was tagged in tweets from @Michel Sidibe the current Executive Director of UNAIDS. See IFMSA tweets here and further analytics here.

to the World Health Assembly; this year has been no different.

Our core reason for this is to amplify the voice of the youth in global health governance. As young people in an era fused with increased information access, we had to come up with a comprehensive visibility strategy so that both stakeholders and actors in and outside of the WHA are made aware of and are able to follow our activities and advocacy priorities.

To achieve such, the following initiatives were taken this year: A presentation was delivered by the Social Media and Public Relations Coordinator regarding social media and advocacy to the Youth Pre-WHA delegates. The goals of this presentation were to help delegates: 1) Recognize social media as a useful and effective advocacy tool; 2) Analyze cases where social media has been utilized for advocacy purposes; 3) Encourage participation in IFMSA preWHA 2018 social media advocacy efforts; 4) Supply tips for effective social media use for advocacy and awareness.

A copy of the Presentation can be found here.

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Official Interventions The agenda of the WHA can be found here, including links to the relevant documents that were discussed. These include: • The Daily Journals (with all essential information for the upcoming day including the agenda of the WHA and official side events); • The main documents for all WHA agenda points; • Information documents; • Resolutions; • Statements submitted by Member States; • Statements submitted by other international organizations; • Statements by Non-State Actors in official relation with WHO IFMSA, as an Non-State Actor in official relation with WHO, had the opportunity to formally speak during the meetings of WHA’s Committees A and B.

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Highlights from WHA71 The following chapter lists highlights from the World Health Assembly, including those that may not have been targeted by the delegation directly.

May 23, 2018 World Health Assembly delegates agreed on an ambitious new strategic plan for the next five years. The Organization’s 13th General Programme of Work (GPW) is designed to help the world achieve the Sustainable Development Goals – with a particular focus on SDG3: ensuring healthy lives and promoting wellbeing for all at all ages by 2030. It sets three targets: to ensure that by 2023, 1 billion more people benefit from universal health coverage; 1 billion more people are better protected from health emergencies; and 1 billion more people enjoy better health and wellbeing. WHO estimates that achieving this “triple billion” target could save 29 million lives.

Speaking to the Health Assembly, Director-General, Dr Tedros Adhanom Ghebreyesus told delegates that the new strategic plan was ambitious because “it must be”. Delegates noted that the Organization will need to make a number of strategic shifts in order to achieve these targets, notably to step up its public health leadership; focus on impact in countries; and ensure that people can access authoritative and strategic information on matters that affect people’s health.

May 24, 2018 Health Assembly delegates called for stepped up action in the global fight to beat noncommunicable diseases (NCDs), including urging for participation by heads of state and government at the Third United Nations General Assembly High-level Meeting on the Prevention and Control of NCDs on 27 September 2018.

Member States reiterated that the international community has committed, in line with the Sustainable Development Goals (SDG), to reduce by one-third by 2030 premature deaths from NCDs, primarily cardiovascular disease, cancers, diabetes and chronic respiratory diseases, and to promote mental health and wellbeing. Each year, 15 million people aged 30

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to 70 years die from an NCD and the current levels of decline in risk of premature death from NCDs are insufficient to meet the SDG NCD target.

The Assembly recognized that enhanced political leadership is needed to accelerate prevention and control of NCDs, such as by implementing cost-effective and feasible “best buys” and other recommended interventions to prevent and control NCDs. These measures include actions to reduce the main disease risks, namely tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets, as well as air pollution.

Health systems must be strengthened by implementing effective measures that better detect people at risk of NCDs and providing drug therapies and services to reduce deaths from heart attacks, stroke and diabetes. Prevention and management of mental disorders also requires urgent action.

Highlights from WHA71 Polio transition: Today delegates considered WHO’s 5-year strategic action plan on polio transition designed to strengthen country health systems impacted by the scaling down and eventual closure of the Global Polio Eradication Initiative (GPEI). The strategic plan was based on the priorities of the national government transition plans, and developed in close collaboration with WHO regional and country offices. The implementation of the plan will require coordination with all country-level and global partners. The plan complements the Africa Immunization Business Case to strengthen immunization systems in the African continent, and also the significant progress made in the integration of the polio functions in the South-East Asian Region.

The strategy supports country ownership of essential polio functions like surveillance, laboratory networks, and some core infrastructure that are needed to (i) sustain a polio-

free world after eradication of polio virus; (ii) strengthen immunization systems, including surveillance for vaccinepreventable diseases; and (iii) strengthen emergency preparedness, detection and response capacity to ensure full implementation of the International Health Regulations.

WHO commits to continue providing technical assistance and resource mobilization support to countries engaged in polio transition. Delegates noted the importance of integrating essential polio functions into national health systems. They proposed that this plan be a “living document” and be revised based on the development of the Programme Budget for 2020-21, and requested an updated report for the 144th Executive Board and the 172nd WHA.

Tuberculosis: Delegates agreed on a resolution urging the WHO DirectorGeneral, Member States and partners to continue support to preparations for the high-level meeting of the UN General Assembly on ending tuberculosis in September this year. The resolution also commits Member States to accelerate their actions to end TB, building on the commitments of the WHO Global Ministerial Conference on Ending TB, held in Moscow in November 2017. It welcomes WHO’s efforts to develop a multisectoral accountability framework towards ending TB and supports its further development, adaptation and use. It also requests the Secretariat to develop a new global strategy for TB research and innovation.

Current efforts to implement the World Health Assemblyapproved End TB Strategy and to meet the SDG target of ending TB are currently falling short. TB claimed 1.7 million lives in 2016 worldwide, including 0.4 million among people with HIV. TB remains the leading infectious disease killer in the world and is one of the top ten global causes of death. It is hoped that the September meeting will prompt a renewal of high-level political commitment to accelerate action to end TB.

Cholera: Delegates endorsed a resolution urging cholera-affected

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Highlights from WHA71 countries to implement a roadmap that aims to reduce deaths from the disease by 90% by 2030. The resolution also urges WHO to increase its capacity to support countries fighting the disease; strengthen surveillance and reporting of cholera; and reinforce its leadership and coordination of global prevention and control efforts. Cholera kills an estimated 95 000 people and affects 2.9 million more every year, disproportionately impacting communities already burdened by conflict, lack of infrastructure, poor health systems and malnutrition. Over 2 billion people worldwide still lack access to safe water and are at potential risk of the disease.

‘Ending Cholera: A Global Roadmap to 2030’ was launched last year by the Global Task Force on Cholera Control (GTFCC) and underscores the need for a coordinated approach to combat the disease with country-level planning for early detection and response to outbreaks, and longterm preventive water, sanitation and hygiene (WaSH) interventions.

May 25, 2018 Digital health: Recognizing the potential of digital technologies to play a major role in improving public health, delegates agreed on a resolution on digital health. The resolution urges Member States to prioritize the development and greater use of digital technologies in health as a means of promoting Universal Health Coverage and advancing the Sustainable Development Goals. It requests that WHO develop a global strategy on digital health and supports the scale-up of these technologies in countries by providing technical assistance and normative guidance, monitoring trends and promoting best practices to improve access to health services.

The resolution also asks Member States to identify priority areas in which they would benefit from WHO assistance, such as implementation, evaluation and scale up of digital health services and applications, data security, ethical and legal issues. Examples of existing digital health technologies include systems that track disease outbreaks by using

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“crowdsourcing” or community reporting; and mobile phone text messages for positive behaviour change for prevention and management of diseases like diabetes.

Snakebite: Delegates agreed a resolution that aims to reduce the number of people around the world who are either killed or are physically or mentally disabled by snakebite. An estimated 1.8 - 2.7 million people are bitten by venomous snakes each year, with between 81 000 and 138 000 people dying as a result. For every person who dies following a snakebite, another four or five are left with disabilities such as blindness, restricted mobility or amputation, and post-traumatic stress disorder. Snakebite overwhelmingly affects people from poor agricultural and herding communities and was categorized

by WHO last year as a high-priority neglected tropical disease. Poor prevention, health worker training, diagnosis and treatment of cases of snakebite, as well as a lack of available tools, are all holding up progress on addressing the global burden of the disease.

Acknowledging the urgent need to improve access to safe, effective and affordable antivenoms for snakebite, delegates urged WHO to accelerate and coordinate global efforts to control snakebite ‘envenoming’ - the life-threatening disease that follows the bite of a venomous snake.

Physical activity: Member States endorsed the WHO Global Action Plan on Physical Activity (GAPPA), a new initiative aimed at increasing participation in physical activity by people of all ages and ability to promote health and beat noncommunicable diseases, including heart disease, stroke, diabetes and breast and colon cancer, and support improved mental health and quality of life. Worldwide, 23% of adults and 81% of adolescents aged 11-17 years do not meet the global recommendations for physical activity. Prevalence of inactivity is as high as 80% in some adult populations influenced by changing patterns of transportation, use of technology, urbanization and cultural values.

Highlights from WHA71 GAPPA provides countries with a prioritized list of policy actions to address the multiple cultural, environmental and individual determinants of physical inactivity. These actions are connected to four objectives that focus on creating active societies, environments, active people and active systems. The plan’s goal is a 15% reduction in the global prevalence of physical inactivity in adults and in adolescents by 2030.

Assistive technology: Delegates adopted a resolution urging Member States to develop, implement and strengthen policies and programmes to improve access to assistive technology and requesting the Director-General to prepare by 2021 a global report on effective access to assistive technology. Assistive technology, such as wheelchairs, hearing aids, walking frames, reading glasses and prosthetic limbs, enables people with difficulties in functioning to live productive and dignified lives, participating in education, the labour market and social life. Without such technology, people with disabilities and older people and others in need are often excluded, isolated and locked into poverty, and the burden of morbidity and disability increases.

An estimated 1 billion people would benefit from assistive products, a number that will rise to more than 2 billion by 2050. Yet 90% do not have access, owing to high costs and a lack of availability. The Director-General was requested to report on progress in the implementation of the present resolution to the Seventy-fifth World Health Assembly and thereafter to submit a report to the Health Assembly every four years until 2030.

International Health Regulations: Delegates welcomed a proposed five-year global strategic plan to improve public health preparedness and response, through implementation of the International Health Regulations. The International Health Regulations (IHR) are an international legal instrument that is binding on 196 countries across the globe, including all WHO Member States of WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.

The IHR, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO. The IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security.

In 2017, WHO recorded a total of 418 public health events in its event management system: the initial source in reporting 136 of these was national government agencies, including National IHR Focal Points. The new strategy aims to help countries strengthen the core capacities they need to implement the regulations, including more reporting through IHR.

Pandemic Influenza Framework (PIP) Framework: Delegates considered the report by the Director-General on progress to implement decision WHA70(10) on Review of the Pandemic Influenza Preparedness Framework. The Health Assembly approved all the recommendations in the Director-

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Highlights from WHA71

General’s report but requested that the final text of the analysis requested in decision WHA70(10)8b, be submitted to WHA 2019 rather than WHA 2020. The Pandemic Influenza Preparedness (PIP) Framework brings together Member States, industry, other stakeholders, and WHO to implement an innovative global approach to pandemic influenza preparedness and response. It was adopted by Member States during the World Health Assembly in 2011.

A key principle in the PIP Framework is that fairness and equity must continue to drive global work to prepare for a pandemic response. Thus, the PIP Framework has two objectives: to strengthen the sharing of influenza viruses with pandemic potential and increase access of developing countries to pandemic vaccines, antiviral medicines and other essential response products.

Rheumatic fever and rheumatic heart disease: Delegates agreed a resolution calling for WHO to launch a coordinated global response to rheumatic heart disease, which affects around 30 million people each year. In 2015, the disease was estimated to have caused 350 000 deaths. The disease most commonly occurs in childhood and disproportionately affects girls and women. Rheumatic heart disease is a preventable condition arising from acute

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rheumatic fever. Despite the availability of effective measures for prevention and treatment of the disease, cases have not significantly declined in recent years. Socioeconomic and environmental factors such as poor housing, undernutrition, overcrowding and poverty increase the likelihood and the severity of the disease.

Improving standards of living, expanding access to appropriate care, and ensuring a consistent supply of quality-assured antibiotics are some of the key strategies that can dramatically reduce the number of people affected.

Delegates called on WHO to reinvigorate efforts to tackle rheumatic fever and to lead and coordinate renewed global efforts for its prevention and control.

May 26, 2018 The Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, told delegates to the World Health Assembly today that they had charted a new course for the Organization.

Closing the Assembly, he said that everything WHO did going forward would be evaluated in the light of the “triple billion” targets which were approved this week in WHO’s new fiveyear strategic plan. By 2023 the targets aim to achieve: • 1 billion more people benefitting from universal

Highlights from WHA71 health coverage • 1 billion more people better protected from health emergencies • 1 billion more people enjoying better health and wellbeing.

On the final day of the Assembly, delegates also came to agreement on maternal, infant and young child nutrition and on poliovirus containment.

Nutrition: Delegates unanimously renewed their commitment to invest and scale up nutrition policies and programmes to improve infant and young child feeding. Member States discussed efforts to achieve the World Health Assembly Global Nutrition Targets, concluding progress has been slow and uneven, but noted a small step forward in the reduction of stunting, with the number of stunted children under 5 years falling from 169 million in 2010 to 151 million in 2017. WHO is leading

global action to improve nutrition, including a global initiative to make all hospitals baby friendly, scaling up prevention of anaemia in adolescent girls, and preventing overweight in children through counselling on complementary feeding. A new report was launched on the implementation of the Code of Marketing Breastmilk Substitutes, highlighting that 6 more countries had adopted or strengthened legislation in 2017 to regulate marketing of breastmilk substitutes.

Polio: With wild poliovirus transmission levels lower than ever before, and the world closer than ever to being polio-free, discussions focused on securing a lasting polio-free world. As at May 2018, only 9 cases due to wild poliovirus had been reported globally, from just 2 countries: Afghanistan and Pakistan. Delegates reviewed emergency plans to interrupt the last remaining strains of the virus.

To prepare for a polio-free world, global poliovirus containment activities continue to be intensified, and Member States adopted a landmark resolution on poliovirus containment. In a limited number of facilities, poliovirus will continue to be retained, post-eradication, to serve critical national and international functions such as the production of polio vaccine or research. It is crucial that poliovirus materials are appropriately contained under strict biosafety and biosecurity handling and storage conditions to ensure that the virus is not released into the environment, either accidentally or intentionally, to again cause outbreaks of the disease in susceptible populations.

Member States expressed overwhelming commitment to fully implement and finance all strategies to secure a lasting polio-free world in the very near term. Rotary International, speaking on behalf of the Global Polio Eradication Initiative (which consists of WHO, Rotary, CDC, UNICEF and the Bill & Melinda Gates Foundation) offered an impassioned plea to the global community to eradicate a human disease for only the second time in history, and ensure that no child will ever again be paralysed by any form of poliovirus anywhere.

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Highlights from WHA71 Closing remarks: In his final speech to this year’s Assembly, Dr Tedros said that everywhere he went, he had the same message: health as a bridge to peace. “Health has the power to transform an individual’s life, but it also has the power to transform families, communities and nations,” he told delegates. The Organization’s new 5-year strategic plan, he said, called on WHO to measure its success not by its outputs, but by outcomes - by the measurable impact it delivers where it matters most - in countries.

“Ultimately, the people we serve are not the people with power; they’re the people with no power,” the Director-

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General said. He told delegates the true test of whether the discussions held in the Assembly this week were successful would be whether they resulted in real change on the ground and he urged them to go back to their countries with renewed determination to work every day for the health of their people.

“The commitment I have witnessed this week gives me great hope and confidence that together we can promote health, keep the world safe, and serve the vulnerable,” he concluded.

Stream Reports:

Noncommunicable Diseases Relevance of the stream: In September 2018 the third UN High-Level Meeting (HLM) on NCDs will commence, a critical opportunity to enhance action, which can be only reached through high-level political commitment, a multi-sectoral approach and an ambitious outcome. The WHA formed one of the key moments in the preparations for the HLM, showed by the relevant agenda points as well as the very high number of NCD-related sideevents. With the great relevance of the topic this WHA, it poses a great opportunity to connect with other stakeholders as well as member states. Furthermore, we could built on the actions and advocacy done on noncommunicable during last preWHA and WHA. Background of the topic: Noncommunicable diseases (NCDs) represent the largest and even growing proportion of the global burden of disease.

In addition to their mortality burden, NCDs commonly lead to significant morbidity, and have major economic consequences worldwide. Premature deaths from NCDs are largely preventable, and many are mainly driven by four big risk factors: physical inactivity, unhealthy diets, tobacco use, and harmful use of alcohol. These risk factors are interrelated, and rooted in social, political, economic, cultural, and commercial factors that often lie outside of individuals’ control. Youth is specifically vulnerable to these risk factors as 70% are started during adolescence. Underfunding, lack of social mobilization, and conflicts of interest with the private sector make this a challenging public health space, but also present an exciting opportunity for coordinated action. While it is agreed by world leaders that the global burden of noncommunicable diseases (NCDs) represents one of the major health challenges of our times, we will not be able to reach Sustainable Development Goal target 3.4 (to reduce premature mortality from NCDs by one-third through prevention and treatment by 2030), based on the current rate of decline in premature mortality from the four main NCDs. With the burden and to reach SDG target 3.4 comes an imminent call to address NCDs within and beyond the health sector, to increase the engagement at the policy level and adapt action to the relevant target audiences. Many key problems and solutions lie outside the health sector, especially in the domains of international finance, trade, and investment policies. There is a need to address the

commercial determinants of health and the threat that (some) private sector companies pose. As previous WHO DirectorGeneral Margaret Chan has noted: “efforts to prevent noncommunicable diseases go against the business interests of powerful economic operators”. Moreover, addressing the role of our environment in preventing non-communicable diseases is key to achieve a better health for all. There is a lot to gain from implementing NCD prevention and treatment in existing communicable diseases and maternal health infrastructures, especially in the aim for Universal Health Coverage. In summary, there is a need to use social determinants of health approach to ensure that health systems are able to combat NCDs in an adequate way. It is crucial to recognize that a paradigm shift is imperative in dealing with NCDs and we need to look beyond the health sector.

Actions by the IFMSA delegation: • Creation and distribution of ‘NCD and Youth’ Policy Brief highlighting 5 key areas for action.

• Meeting with Member States to discuss key challenges in the prevention and control of NCDs, including advocating for meaningful engagement of young people in all NCDs initiatives • Statements on the following agenda points • Preparation for the third High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable diseases, to be held in 2018 • Health, Environment and Climate Change • Physical Activity for Health • Maternal, Infant and Young Child Nutrition • Active participation in the majority of NCD related sideevents Follow up: • Use the preWHA and WHA in the preparation for the UN HLM on NCDs • Follow-up with stakeholders, member states and other contacts from during the WHA • Keep advocating for our priorities within the NCD debates

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Stream Reports: Antimicrobial Resistance Relevance of the stream: This year in September, a High-Level Meeting on Tuberculosis will be held during the High-Level Week of the United Nations General Assembly. Tuberculosis being only the sixth health issue in the history to have a High-Level Meeting at the UNGA, year 2018 provides IFMSA with a unique opportunity to advocate for a world free of Tuberculosis and Antimicrobial Resistance. Tuberculosis and AMR are highly interlinked topics, with an estimated 1/3 of all AMR related deaths to be caused by drug-resistant TB. The 71st WHA will include several opportunities, both inside and outside the Palais des Nations, to discuss and actively advocate for IFMSA´s stances related to AMR and TB. Background Information: Antimicrobial Resistance (AMR) is one of gravest threats to human health in the history of medicine. It is estimated that if nothing is done, the mortality due to AMR will continue its steep rise and by 2050, lead to more deaths than cancer today(10 million and 7 million, respectively). What more, it will have devastating effects on global economy, especially those of the LMIC countries where the health systems are already fragile. According to a recent report by World Bank, the effect of AMR on global economy will equal the financial crisis of 2008-09, with the exception that the effect of AMR will be sustained for many years to come.

Actions by the IFMSA delegation: • Creation and distribution of an “Ending TB” Policy Brief.

• Presence and active engagement in the majority of Antimicrobial Resistance related side events • Bilateral meetings with several high-level stakeholders in the field.

• Approaching and actively engaging with relevant stakeholders in the field of Tuberculosis and AMR • Delivering a statement together with the World Health Students´ Alliance in the agenda point: Preparing for a High-Level Meeting on Tuberculosis

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Follow up: • Several stakeholders have been contacted after the Assembly with plans on further collaboration.

• A possibility for panel appearance by IFMSA at one of the side-events at the High-Level Meeting on Tuberculosis is being followed up on.

Stream Reports: Discrimination in Health Relevance of the stream: Discrimination in healthcare settings faced by people living with and most affected by HIV and other key populations has shown to be a major impediment to health. It is an extremely important topic to tackle during medical training, to ensure everyone regardless of their status or condition receives the highest attainable quality of care. Following on last year’s action during Pre-WHA and WHA this year’s World Health Assembly was another great opportunity to showcase our commitment and further advance the work IFMSA does as part of the Zero Discrimination Agenda. Through our collaboration with UNAIDS and other community key agents we are ensuring we stay in the forefront and that our actions make a positive change.

Background of the topic: Discriminatory patterns in healthcare systems affect the efficacy of preventive strategies, the utilisation of testing methods, the enrolment in and adherence to treatment and the frequency of medical consultation in general. Studies conducted for the HIV Stigma Index revealed for example that a quarter of people living with HIV reported to have experienced some form of discrimination in healthcare. It has also been shown that people who perceive high levels of HIVrelated stigma are 2.4 times more likely to delay enrolment in care until they are very ill. Examples of faced discriminatory situations or concepts are: • Limitation of access to comprehensive sexuality education and to prevention methods for key populations due to paucity of needs-related offers, • Denial of treatment and other health services such as maternal care, dental care or family planning services, • Restriction of the patient’s autonomy in clinical settings, e.g. undergoing coerced abortion or sterilisation, • Violation of privacy and confidentiality by disclosing a patient’s HIV sero-status to family members or hospital employees without authorisation, • Demands for additional payment for infection control,

• Conduction of unnecessary precaution procedures, e.g. health providers isolating and minimising contact with the patients, • Prejudgement of people living with HIV, e.g. believing that people acquired HIV because they have engaged in irresponsible behaviour, • Provision of antiretroviral therapy made dependent on the use of contraception or people’s sexual behaviours.

• Provision of a poorer quality of care to people living with HIV compared to other patients.

This results in an overall impairment of HIV-related care provided by individuals, institutions and systems: It leads to an increased likelihood for key populations to be exposed to a risk of an HIV transmission and to poor health outcomes for people that have acquired HIV. Hence, the end of AIDS cannot be reached unless discrimination is adequately addressed and eliminated from all clinical settings.

This can only be attained when health workers as the core of healthcare provision are made aware of their responsibility in this issue and are taught a rights-based, people-centred and non-stigmatising healthcare.

Actions by the IFMSA delegation: • Presence in the majority of Sexual and Reproductive Health and Rights related side events, including the launch of the SRHR Lancet report and a SheDecides consultation.

• Creation, printing and distribution of an “Ending AIDS by 2030” Policy Brief.

• Approaching all the relevant stakeholders in the HIV response, including the member states of the participants present in the stream and the different civil societies relevant to the topic.

Follow up: • Follow up with the different civil societies and contacts that were approached during the World Health Assembly.

• Keep pushing so IFMSA stays involved in all actions related to ending discriminatory attitudes in healthcare and is seen as a major stakeholder on the topic.

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Stream Reports: Universal Health Coverage Relevance of the stream: The central theme of this year’s World Health Assembly was Universal Health Coverage. In his first few months as DirectorGeneral, Dr Tedros Ghebreyesus famously wrote that ‘all roads lead to universal health coverage’. Accordingly, he has shifted WHO’s priority focus areas to centre around UHC. Put simply, UHC means that all people are able to access the health services they need, when they need them, at a price they can afford. This coincides extremely well with IFMSA’s focus areas, as the peak representative body for medical students from around the world. Without access to healthcare, there can be no health. UHC, then, is the road to better health for all.

Background of the topic: According to WHO, UHC ‘means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need.’ For this to occur, high quality healthcare services need to be provided, and they need to be accessible to the people who need them.

Further, they must be able to be accessed without suffering financial hardship. Importantly, UHC is not something to be ‘achieved’; that is, it is not a dichotomous outcome. Rather, health coverage is something that can be improved. Every country can work to increase the number of people covered, the services covered, and minimise the out-of-pocket costs that patients are forced to pay. WHO has a key leadership and standard-setting role here, which this year’s WHA showed.

Actions by the IFMSA delegation: Policy briefs: We created two policy briefs, which we used to guide our advocacy efforts when approaching Members States and other actors at the Assembly.

1. mHealth: This policy recommended, among other things, increased integration and interoperability of digital health services, and stressed the importance of electronic medical record systems.

2. Health workforce: This policy focused on minimising the harmful effects of the global brain drain of health

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workers, and improving the quality of services and personnel in resource-poor and conflict-affected settings.

Statements: 1. Addressing the global shortage of, and access to, medicines and vaccines 2. Global strategy and plan of action on public health, innovation and intellectual property 3. mHealth 4. Improving access to assistive technology Side events and other activities: We had a significant presence at the vast majority of side events at the WHA, most (or rather, all) of which were centred around UHC. This gave us a chance to mix with other delegates, and to ask probing questions of panellists and speakers.

Follow up: • Following on from the WHA, IFMSA is now an official member of UHC2030, a global partnership which seeks to accelerate progress towards UHC, in line with the UN Sustainable Development agenda.

• There will be a High-Level Meeting on UHC in 2019, which IFMSA will attend, representing the youth voice in this peak global arena.

Side Events Co-Hosted by IFMSA Technical Briefing on Primary Health Care for Universal Health Coverage

Youth Town Hall: An informal meeting hosted by the Senior Advisor on Gender and Youth

The 1978 Declaration of Alma-Ata was the first international declaration to advocate for primary health care as the main strategy to achieve WHO’s stated goal of health for all. Since then, strong primary care systems, based in local communities, are recognized to be essential to achieving universal health coverage. The core values and principles of the 1978 Declaration of Alma-Ata still stand, and at the Global Conference on Primary Health Care: Towards Health for All, to be held in October this year in Astana, Republic of Kazakhstan the global community is expected to renew the emphasis on primary care as the main driver of people-centred health systems leading to universal health coverage. Making health care truly universal requires a shift from health systems designed around diseases and health institutions towards health systems designed around and for people. The technical briefing will review lessons learned on the implementation of primary health care over these past four decades. This will inform the future implementation of primary health care toward universal health coverage in our globalized world.

This World Health Assembly has seen the very first Youth Town Hall of WHO’s history, hosted at the WHO Headquarters.

Youth representatives from several youth-serving and youthled organizations gathered to discuss meaningful youth participation in global health. The discussion was facilitated

by Ms. Diah Satyani Saminarsih, the WHO Director-General’s Advisor on Gender and Youth with the help of Dr. Amine Lotfi IFMSA’s Liaison Officer to the WHO. Champions of youth engagement within the WHO and from other organizations were invited as panelists to share experiences and best practices. At the end of the Town Hall, participants agreed to keep the debate open and to reconvene a similar meeting at the next World Health Assembly.

Taking civil society engagement to new heights to advance WHO’s 13th General Programme of Work and achieve the Triple Billion targets In his inaugural address to WHO staff as Director-General, Dr Tedros outlined his priorities for the organization and for global health, with the first being universal health coverage.

In achieving this goal, he underscored the necessity for partnerships and collaboration with civil society organizations (CSOs), especially through country-level engagement, a theme echoed in WHO’s draft thirteenth General Programme of Work (GPW). In this context, this side event intends to foster dialogue and build consensus among Member States, WHO staff, and CSOs around how civil society can best contribute – in partnership with WHO and governments at all levels and in varying contexts – to delivering the goal of health for all.

Health of Palestinians & Palestine Refugees: 70 years after Nakba (Catastrophe) Under the auspices of the Lancet and UNRWA, and in collaboration with the World Health Organization (WHO), the International Federation of Medical Students’ Associations (IFMSA) and Medical Aid for Palestinians (MAP) - UK, the side event explored the status and raised awareness on the health situation of over 5.3 million Palestine refugees in Palestine (West Bank and Gaza), Jordan, Syria and Lebanon.

A panel discussion highlighted the factors that negatively affect the health and well-being of Palestinians and Palestine refugees, who live under extremely volatile and difficult conditions, especially in a region where occupation, conflicts and instability are prevailing, and the possible ways to deliver lifesaving and essential health services in such contexts.

IFMSA will follow up on these discussions and will foster its relationship with UNRWA in an appeal to medical students and their organizations to support UNRWA’s efforts in this area.

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Algeria (Le Souk)

Latvia (LaMSA)

Senegal (FNESS)

Argentina (IFMSA-Argentina)

El Salvador (IFMSA-El Salvador)

Lebanon (LeMSIC)

Serbia (IFMSA-Serbia)

Armenia (AMSP)

Estonia (EstMSA)

Lesotho (LEMSA)

Sierra Leone (SLEMSA)

Australia (AMSA)

Ethiopia (EMSA)

Libya (LMSA)

Singapore (AMSA-Singapore)

Austria (AMSA)

Fiji (FJMSA)

Lithuania (LiMSA)

Slovakia (SloMSA)

Azerbaijan (AzerMDS)

Finland (FiMSIC)

Luxembourg (ALEM)

Slovenia (SloMSIC)

Bangladesh (BMSS)

France (ANEMF)

Malawi (UMMSA)

South Africa (SAMSA)

Belgium (BeMSA)

Gambia (UniGaMSA)

Mali (APS)

Georgia (GMSA)

Spain (IFMSA-Spain)

Bolivia (IFMSA-Bolivia)

Malta (MMSA)

Sudan (MedSIN)

Bosnia & Herzegovina (BoHeMSA)

Germany (bvmd)

Mexico (IFMSA-Mexico)

Sweden (IFMSA-Sweden)

Mongolia (MMLA)

Switzerland (swimsa)

Montenegro (MoMSIC)

Syrian Arab Republic (SMSA)

Morocco (IFMSA-Morocco)

Taiwan - China (FMS)

Namibia (MESANA)

Thailand (IFMSA-Thailand)

Nepal (NMSS) The Netherlands (IFMSA NL)

The Former Yugoslav Republic of Macedonia (MMSA)

Nicaragua (IFMSA-Nicaragua)

Tanzania (TaMSA)

Nigeria (NiMSA)

Togo (AEMP)

Norway (NMSA)

Trinidad and Tobago (TTMSA)

Oman (MedSCo)

Tunisia (Associa-Med)

India (MSAI)

Pakistan (IFMSA-Pakistan)

Turkey (TurkMSIC)

Catalonia - Spain (AECS)

Indonesia (CIMSA-ISMKI)

Palestine (IFMSA-Palestine)

Chile (IFMSA-Chile)

Iran (IMSA)

Panama (IFMSA-Panama)

Turkey – Northern Cyprus (MSANC)

China (IFMSA-China)

Iraq (IFMSA-Iraq)

Paraguay (IFMSA-Paraguay)

Uganda (FUMSA)

China – Hong Kong (AMSAHK)

Iraq – Kurdistan (IFMSA-Kurdistan)

Peru (IFMSA-Peru)

Ukraine (UMSA)

Peru (APEMH)

United Arab Emirates (EMSS)

Colombia (ASCEMCOL)

Ireland (AMSI)

Philippines (AMSA-Philippines)

Costa Rica (ACEM)

Israel (FIMS)

Poland (IFMSA-Poland)

Croatia (CroMSIC)

Italy (SISM)

Portugal (ANEM)

United Kingdom of Great Britain and Northern Ireland (SfGH)

Cyprus (CyMSA)

Jamaica (JAMSA)

Qatar (QMSA)

Czech Republic (IFMSA-CZ)

Japan (IFMSA-Japan)

Republic of Moldova (ASRM)

United States of America (AMSA-USA)

Democratic Republic of the Congo (MSA-DRC)

Jordan (IFMSA-Jo)

Romania (FASMR)

Uruguay (IFMSA-URU)

Kazakhstan (KazMSA)

Russian Federation (HCCM)

Uzbekistan (Phenomenon)

Denmark (IMCC)

Kenya (MSAKE)

Venezuela (FEVESOCEM)

Dominican Republic (ODEM)

Korea (KMSA)

Russian Federation – Republic of Tatarstan (TaMSA)

Ecuador (AEMPPI)

Kosovo - Serbia (KOMS)

Rwanda (MEDSAR)

Zambia (ZaMSA)

Egypt (IFMSA-Egypt)

Kuwait (KuMSA)

Saint Lucia (IFMSA-Saint Lucia)

Zimbabwe (ZiMSA)

Bosnia & Herzegovina – Republic of Srpska (SaMSIC) Brazil (DENEM)

Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada)

Brazil (IFMSA-Brazil)

Guatemala (IFMSA-Guatemala)

Bulgaria (AMSB)

Guinea (AEM)

Burkina Faso (AEM)

Guyana (GuMSA)

Burundi (ABEM)

Haiti (AHEM)

Cameroon (CAMSA)

Honduras (IFMSA-Honduras)

Canada (CFMS)

Hungary (HuMSIRC)

Canada – Québec (IFMSA-Québec)

Iceland (IMSA)

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medical students worldwide

Yemen (NAMS)