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The right to mental health in armed conflict: A human rights framework for protection and compliance

Published online by Cambridge University Press:  26 August 2026

Khaled Hassine Open the ORCID record for Khaled Hassine [Opens in a new window]
Khaled Hassine*
Affiliation:
Lawyer, Geneva, Switzerland
*
Email: kh.hassine@gmail.com
Rights & Permissions [Opens in a new window]

Abstract

Mental health constitutes an integral and indivisible dimension of the right to the highest attainable standard of physical and mental health under international law. Yet, the specific obligations it generates for States in situations of armed conflict would benefit from a cross-sectoral discussion and engagement to enrich emerging understandings in both legal doctrine and institutional practice, with a view towards a comprehensive analytical framework. This article argues that the right to health framework, anchored in the International Covenant on Economic, Social and Cultural Rights and other core human rights treaties, provides a legally coherent and operationally applicable framework for the protection of mental health in armed conflict. It examines how the Availability, Accessibility, Acceptability and Quality framework, minimum core obligations, the requirement of non-retrogression and the duty to use maximum available resources operate in conditions of armed conflict. It also considers how to operationalize this framework, which recognizes affected persons as rights holders and engages legal responsibility of States as duty bearers as a condition for effective safeguarding of the right to mental health in armed conflict.

Keywords

human rightsright to healthmental healtharmed conflictICESCRCRPDhuman rights-based approachminimum core obligationsunderlying determinants

Information

Type
Research Article
Information
International Review of the Red Cross , Volume 108 , Special Issue 932: Mental Health and Armed Conflict , August 2026 , pp. 779 - 800
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of International Committee of the Red Cross.

Health is a human right, not a privilege, and there is an urgent need for accountability and a recommitment to protect health in conflict.

Volker Türk, UN High Commissioner for Human RightsFootnote 1

Introduction

The recognition of mental health as a constitutive element of the right to health has brought growing focus on the physical and mental health consequences of armed conflict and greater attention to legal and policy frameworks capable of protecting the rights of affected populations. Much of the contemporary legal discussion is conducted through the lens of international humanitarian law (IHL), particularly in relation to attacks on health-care infrastructure and personnel.Footnote 2 As much as IHL remains indispensable in regulating the conduct of parties during armed conflict, a framework encompassing human rights law can help to broaden the understanding of mental health protection and to develop adequate person-centred responses and accountability pathways.Footnote 3 Yet, the international human rights law (IHRL) discussion on mental health in armed conflict is still emerging.Footnote 4

The impact of armed conflict on the enjoyment of human rights, including the right to physical and mental health, is profound and closely linked to broader social and economic conditions. It is often cumulative, long-term, and disproportionately affects certain groups that are at heightened risk of human rights violations. Mental health is shaped by intersecting factors such as social class, race, ethnicity, historical discrimination, poverty, housing, food, water and sanitation, education, and exposure to armed violence, conflict or disaster.Footnote 5 Armed conflicts exacerbate pre-existing mental health conditions and generate new ones.Footnote 6 They do not merely damage health infrastructure, incidentally or through direct attacks – they also systematically destroy the underlying conditions necessary for mental health to be sustained.Footnote 7 The right to health provides a framework for linking mental health to the broader social, economic and political conditions through which the enjoyment of this right is either sustained or eroded, and for naming and addressing this broader human rights impact. Addressing these effects raises questions that extend beyond the immediate regulation of violence and requires engagement with legal frameworks capable of capturing the underlying determinants and long-term impacts.

This article examines how the right to health, as articulated under IHRL, provides a normative and operational framework for the protection of mental health in armed conflict. Anchored in the International Covenant on Economic, Social and Cultural Rights (ICESCR) and related human rights instruments, the analysis explores how core principles of the right to health can inform both the design of mental health systems and the assessment of State compliance with relevant obligations towards the creation of pathways for accountability (the IHRL obligations of non-State actors remain outside the scope of the analysis). In doing so, the article seeks to contribute to a more integrated understanding of the protection of the right to physical and mental health, situating it within the broader architecture of human rights obligations that continue to apply before, during and after armed conflict. Ultimately, the article proposes that safeguarding the right to mental health requires moving beyond reactive crisis response and towards long-term approaches that are firmly grounded in human rights.

The right to health as a safeguarding frameworkFootnote 8

The right to health provides more than a normative entitlement to health care – it constitutes a safeguarding framework laying the normative basis for addressing the continuum of risks and differentiated impacts affecting the enjoyment of mental health before, during and after conflict. Beyond the obligations it imposes on States regarding access to health care, its significance in situations of armed conflict lies in its capacity to structure prevention, accountability and the continuity of protection in circumstances of armed conflict, where mental health harm becomes pervasive yet insufficiently documented. Unlike frameworks activated by the existence of armed conflict, right to health obligations apply continuously, requiring States to invest in mental health systems before conflicts emerge, and to maintain them during and after the conflict. This temporal breadth is among the framework’s most distinctive legal and juridical characteristics.

The right to mental health constitutes an integral and indivisible component of the right to the highest attainable standard of physical and mental health guaranteed under Article 12 of the ICESCR. The Committee on Economic, Social and Cultural Rights (CESCR) has clarified that the right to health is an inclusive right, extending not only to timely and appropriate health care but also to the underlying determinants of health, thereby encompassing conditions necessary for physical, mental and social well-being, and going beyond a narrow conception limited to the absence of disease.Footnote 9 The indivisibility of physical and mental health has important operational consequences in conflict settings. A State cannot satisfy its obligations under Article 12 of the ICESCRFootnote 10 by maintaining certain physical health services while allowing mental health systems, biopsychosocialFootnote 11 support structures and community-based care to collapse. The health system must be understood as a whole, and mental health is not severable from it.

The inclusion of mental health in the scope of Article 12 reflects an understanding of health as a holistic state, encompassing biological, psychological and social dimensions. The CESCR’s General Comment 14 provides interpretative guidance for Article 12. The reference to, inter alia, the prevention and treatment of “mental illness [sic]” confirms that States Parties are under positive obligations to develop and maintain mental health care as a component of the overall health system.Footnote 12 This is not a peripheral entitlement but an integral dimension of the right to health, underpinning obligations that apply to the organization and delivery of health systems as a whole. Embedding mental health also within primary health-care systems can widen access, particularly for persons and groups that traditionally have limited access to mental health services.Footnote 13

Among the other core human rights treaties – such as the Conventions on the Rights of the ChildFootnote 14 and the Convention on the Elimination of All Forms of Discrimination against WomenFootnote 15 – that include provisions on the right to health, the Convention on the Rights of Persons with Disabilities (CRPD)Footnote 16 is central in relation to mental health. The CRPD applies to persons with psychosocial disabilities, requiring States Parties to provide them with the same range, quality and standard of free or affordable health care as is provided to other persons.Footnote 17

Central to this analysis is the continued applicability of ICESCR obligations during armed conflict.Footnote 18 The ICESCR has not been written for times of peace alone; unlike for some provisions of the International Covenant on Civil and Political Rights (ICCPR),Footnote 19 the ICESCR contains no derogation clause permitting States to suspend or set aside their obligations during public emergencies or armed conflict.Footnote 20 This structural feature is legally significant: it indicates that the Covenant was not designed to accommodate the suspension of economic, social and cultural rights, even in acute circumstances.

Rather, the Covenant’s flexibility is inherent through the built-in concepts of “progressive realization” and “maximum available resources” under Article 2(1). These incorporate a degree of accommodation appropriate to periods of armed conflict. Within that structure, the CESCR has consistently affirmed that certain obligations are of immediate effect and non-derogable in all circumstances, including the obligation of non-discrimination, minimum core obligations including those relating to the right to health, and the duty to take deliberate and concrete steps toward the realization of that right.Footnote 21 The ICESCR therefore operates as a system of structured flexibility that adjusts the pace of implementation to available capacity, without the need for a derogation provision.

Similarly, Article 11 of the CRPD, which explicitly refers to armed conflict, creates a non-derogable obligation in relation to the protection of persons with psychosocial disabilities.Footnote 22 According to the CRPD, States must take all necessary measures to protect persons with psychosocial disabilities in situations of risk, including armed conflict.Footnote 23 Emergency response planning and humanitarian operations therefore need to integrate a disability-inclusive approach, and persons with psychosocial disabilities should not be abandoned in situations of mass displacement or evacuation from institutional settings.Footnote 24

This concurrent applicability or interoperability of IHRL and IHL during armed conflict, including situations of occupation, is recognized in international law.Footnote 25 The International Court of Justice (ICJ) affirmed in its 2004 Advisory Opinion on the Legal Consequences of the Construction of a Wall in the Occupied Palestinian Territory that IHRL applies alongside IHL, including in situations of occupation, and that the Occupying Power remains bound by ICESCR obligations, including with respect to the right to health. The Court reaffirmed this position in its 2005 judgment in Armed Activities on the Territory of the Congo, applying concurrent applicability in a binding ruling,Footnote 26 as well as its 2024 Advisory Opinion on the Legal Consequences Arising from the Policies and Practices of Israel in the Occupied Palestinian Territory, including East Jerusalem.Footnote 27

This understanding is reflected in the practice of the CESCR, which has reiterated that the ICESCR continues to apply in situations of armed conflict alongside IHL. The CESCR has also drawn directly on this jurisprudence in its country-specific monitoring, calling on States Parties engaged in armed conflict, including occupation, to comply with their Covenant obligations in conformity with the ICJ’s reasoning. The Committee has emphasized that no derogation from Covenant obligations is permitted and that States remain bound to ensure the progressive realization of rights for all persons under their jurisdiction, including in territories affected by hostilities.Footnote 28 The convergence between judicial authority and treaty body practice establishes concurrent applicability as the operative legal framework within which the right to health must be assessed in situations of armed conflict.

A human rights-based approach to mental health in armed conflict

Although awareness of mental health issues has increased significantly in recent years, progress remains uneven and insufficiently anchored in international human rights standards. In many contexts, mental health systems continue to operate through fragmented understandings of what the right to health entails. As a result, stigma, discrimination and harmful practices remain deeply entrenched. In situations of crisis and armed conflict, where institutional safeguards are weakened, challenges become even more pronounced.

A human rights-based approach to mental health represents a fundamental reorientation of how mental health systems are understood, organized and evaluated. Rather than framing mental health responses within a predominantly clinical or biomedical model in which persons are mainly treated as patients and recipients of health care, the approach reconceives persons experiencing mental health conditions as rights holders whose independence, autonomy, dignity and participation must be placed at the centre of any response.Footnote 29 This paradigm shift derives from the international human rights framework, and in particular the CRPD, given its centrality in transforming mental health practice. The CRPD has reinforced the protection offered by the existing international human rights framework in the field of mental health, bringing greater understanding of the related obligations and created an enabling legal environment from which to develop rights-based mental health systems.Footnote 30 It has moved the question of mental health care away from the domain of clinical discretion and toward the domain of legal obligation, subjecting mental health systems to the full architecture of human rights accountability.

The joint guidance issued by the Office of the United Nations High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO) on mental health, human rights and legislation operationalizes this approach and offers practical standards against which State compliance can be assessed.Footnote 31 It identifies a set of core elements of a human rights-based approach to mental health legislation and policy, including the elimination of involuntary treatment and institutionalization, the promotion of supported decision-making and community-based care, the integration of mental health into general health systems rather than separate psychiatric structures, and the meaningful involvement of persons with lived experience in the design, governance and evaluation of mental health systems. These standards apply to armed conflict, though their operationalization requires specific attention to the conditions of instability, displacement and institutional disruption that characterize such contexts.

In line with a human rights-based approach to mental health, and despite the operational pressures of armed conflict and some State practice, the isolation of persons with mental health conditions or psychosocial disabilities is incompatible with the prohibition of deprivation of liberty on the basis of disability, including psychosocial disability, under any circumstances, as enshrined in Article 14 of the CRPD.Footnote 32 Disruptions to community-based care, displacement and the collapse of social support networks may produce institutional responses, including placement in psychiatric hospitals, that constitute deprivation of liberty under Article 14 regardless of their therapeutic framing and would therefore be incompatible.Footnote 33

A recurring challenge in armed conflict is the expansion of coercive mental health practices under the justification of emergency necessity. Persons with psychosocial disabilities may be subjected to involuntary hospitalization, forced medication, physical restraint or confinement in conditions falling below minimum standards of humane treatment. The CRPD framework, reinforced by the interpretive elaborations of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (SR Health), is unequivocal: emergency conditions do not justify derogation from the right to autonomy and free and informed consent in mental health care.Footnote 34

Finally, a human rights-based approach requires participation not as a procedural formality but as a substantive safeguard against the risks of involuntary treatments or institutionalization, which tend to be amplified in conflict settings.Footnote 35 Persons with lived experience of mental health conditions, organizations of persons with psychosocial disabilities, and community-based groups representing affected populations possess knowledge that is indispensable to the design of human rights-compliant responses. Creating conditions under which persons whose mental health may be most affected in armed conflict can contribute meaningfully requires structural investment in participation.

Towards accountability pathways: challenges and opportunities

In recent years, mental health – and increasingly, the right to mental health – has come to be recognized across a wide range of international and intergovernmental fora as central to effective responses to crises, including armed conflicts, natural disasters and other emergencies. This growing political acknowledgment is reflected in a series of resolutions, policy frameworks and programmatic commitments that position mental health as a core component of humanitarian, health and human rights action.

At the humanitarian level, the adoption of Resolution 33IC/19/R2 at the 33rd International Conference of the Red Cross and Red Crescent (International Conference) in 2019,Footnote 36 together with its 2024 progress report, marked an important step in consolidating international consensus on the need to address the mental health and psychosocial needs of populations affected by crises.Footnote 37 Similarly, the mental health and psychosocial support programming of the Office of the UN High Commissioner for Refugees (UNHCR), alongside Executive Committee Conclusion No. 116 (LXXIII) adopted in 2022, reflects a sustained commitment to integrating mental health and psychosocial well-being as essential elements of protection and assistance responses.Footnote 38 These frameworks emphasize early identification of needs, reduction of stigma, and the provision of accessible, culturally appropriate and rights-based services. At the same time, they increasingly incorporate monitoring, evaluation and data collection practices, signalling an emerging emphasis on measuring outcomes and ensuring the effectiveness of interventions.

This political momentum has been further reinforced within global health governance. The adoption in 2024 of World Health Assembly Resolution WHA77.3 underscores the importance of strengthening mental health and psychosocial support before, during and after emergencies, and highlights the need to guarantee access to quality mental health services as part of the realization of the right to health.Footnote 39 Crucially, more recent developments within the human rights system have contributed to consolidating the position of mental health as a matter of legal entitlement and not only public health policy. In its latest recent resolution on mental health and human rights adopted in March 2026, the UN Human Rights Council reaffirmed mental health as a fundamental human right and emphasized the obligation to integrate mental health and psychosocial support into responses, including in situations of armed conflict.Footnote 40

The convergence of humanitarian, global health and human rights frameworks around mental health in crisis is important progress – but convergence in political recognition is not the same as convergence in legal and conceptual frameworks. Beneath the shared vocabulary of mental health and biopsychosocial support, these systems operate from different foundational assumptions about the nature of the harm, the identity of the affected person and the character of the response required.

The right to health as a normative monitoring framework

The Availability, Accessibility, Acceptability and Quality framework

The operational architecture of the right to health has been articulated by the CESCR through the Availability, Accessibility, Acceptability and Quality (AAAQ) framework.Footnote 41 These four dimensions define the substantive content of States’ obligations regarding the conditions necessary for the right to physical and mental health to be realized and protected. They articulate the legal content of State obligations and provide the normative framework for assessing compliance.Footnote 42 Their value lies in their application to the health system as a whole, rather than single services or incidents.

The right to health requires continuous monitoring against the AAAQ framework of the degree to which the right to mental health is enjoyed in practice. The objective is not to assess whether societies are free from mental health challenges but to evaluate whether the conditions necessary for the enjoyment of the right are being progressively realized, protected from deterioration and made accessible on an equal basis. From this perspective, the focus shifts from clinical outcomes towards the broader legal, institutional, social and material conditions through which mental health is either sustained or undermined over time.

The destruction or disruption of mental health infrastructure is among the visible consequences of armed conflict.Footnote 43 The deliberate or incidental destruction of facilities, the forced displacement of specialized personnel and the disruption of pharmaceutical supply chains, in as much as they undermine the availability of mental health services and essential medicines, may amount to violations of the availability requirement, as articulated by the CESCR. A State bears the burden of demonstrating, plausibly, that it has taken all reasonable steps, to the maximum of its available resources, to prevent or remedy such shortages through alternative delivery modalities and, where necessary, recourse to international assistance.Footnote 44 In other words, the availability requirement generates a positive obligation, not a basis for invoking force majeure.Footnote 45 Safeguarding the right to mental health requires not merely assessing whether infrastructure formally exists, but examining whether conflict progressively erodes the broader ecosystems and underlying determinants on which mental health depends. As these systems degrade, availability must be understood in functional rather than formal terms. The State’s obligations shift to preserving the operational integrity of the health system, requiring anticipatory measures, adaptive service delivery and efforts to ensure the continuity of essential mental health care under conditions of systemic disruption.

The social-ecological framework that foregrounds the structural determinants of mental well-being, including access to social protection, community belonging, and freedom from violence,Footnote 46 situates mental health beyond a public health concern as a condition shaped by the social, economic and political environment – one that armed conflict critically degrades and destroys. The implication is that assessments of State compliance cannot be limited to service provision data but must examine the broader determinants required for mental health protection.

In armed conflict, mental health services may formally remain available while becoming inaccessible for segments of the population. Physical inaccessibility such as for older personsFootnote 47 or persons with disabilities,Footnote 48 economic destitution among displaced populations,Footnote 49 linguistic and administrative barriers facing refugees and minorities,Footnote 50 and the discriminatory de-prioritization of mental health services for certain groups each engage distinct legal obligations under the four-dimensional accessibility standard.Footnote 51

The acceptability dimension acquires particular significance in armed conflict, where coercive approaches to mental health may expand under the justification of operational necessity. The right to health framework requires that mental health care is grounded in free and informed consent,Footnote 52 a requirement that emergency conditions do not suspend.Footnote 53

The quality dimension of the right to health requires that health services be scientifically and medically appropriate and of good quality, including in the area of mental health.Footnote 54 In situations of armed conflict, pressures on health systems often disrupt continuity of care, weaken mental health services and erode workforce capacity, supervision and the use of evidence-based interventions. Safeguarding the right to mental health requires maintaining standards that ensure health services are safe, effective and appropriate to the needs of affected populations. Without such safeguards, mental health responses themselves risk causing harm, reinforcing exclusion or retraumatizing individuals.

Immediate and cross-cutting obligations

The right to health framework also imposes immediate cross-cutting obligations that remain applicable irrespective of resource constraints. These include obligations of non-discrimination and equality, as well as minimum core obligations necessary to ensure at least essential levels of the right to health.Footnote 55

The concept of minimum core obligations is central to the legal analysis of the right to mental health in armed conflict, as it establishes a baseline of essential entitlements that States must secure.Footnote 56 The CESCR has stated that this includes ensuring access to health facilities, goods and services in a non-discriminatory manner and providing essential medicines, thus ensuring that they are available and accessible, including affordable.Footnote 57 These obligations represent the irreducible floor below which States cannot fall, even in the face of resource constraints or security considerations.Footnote 58

In the context of mental health, minimum core obligations require for conflict-affected populations: (1) the provision of first-line mental health care; (2) the availability of essential psychotropic medicines on the WHO Essential Medicines List; (3) non-discriminatory access to mental health services for all persons within the State’s jurisdiction; and (4) the maintenance of at least basic community mental health services and crisis response capacity.Footnote 59

At the centre is the non-discrimination obligation, which is an immediate and cross-cutting obligation. A State which maintains mental health services but structures them in ways that systematically exclude conflict-affected or displaced populations does not comply with its obligations under the right to health. There is no proportionality calculus that authorizes discriminatory access to mental health services, and the prohibition against discrimination under Article 2(2) of the ICESCR is an immediate and non-derogable obligation that is applicable at all times, including in situations of armed conflict.Footnote 60 Even in situations of armed conflict, therefore, States need to ensure that groups in situations of vulnerability or marginalization have equal access to health care and support systems.

Article 2(1) of the ICESCR requires States Parties to take steps, to the maximum of their available resources, with a view to achieving progressively the full realization of the right to health. While this formulation acknowledges the constraints under which States operate in armed conflict, progressive realization is not a permission to regress.Footnote 61 The diversion of health resources, the closure of health facilities or the de-prioritization of mental health carry an affirmative burden of justification by the State.Footnote 62 States that direct resources away from mental health services in the name of conflict-related priorities, including security, infrastructure or economic recovery, need to demonstrate that such decisions represent the most human rights-compatible allocation achievable given the full range of their obligations.Footnote 63

The non-retrogression principle also applies to legislative and institutional changes. The dissolution of mental health institutions, the repeal of legal protections for persons with psychosocial disabilities or the abandonment of community mental health programmes in conflict-affected areas are retrogressive measures requiring reasoned justification. The obligation to justify retrogression places the evidentiary burden on the State, not on those claiming that their rights have been violated.Footnote 64

The duty to use maximum available resources is not a ceiling on the obligation, but an obligation itself. States need to mobilize domestic resources or, if necessary, seek international assistance for mental health in conflict.Footnote 65 The requirement does not simply function as a mitigating qualifier on the scope of obligation; it is simultaneously an obligation on its own, requiring States to ensure that all available resources, including international assistance and cooperation, are mobilized and deployed in ways that prioritize health.Footnote 66

These obligations require States to take deliberate, concrete and targeted steps towards the full realization of the right to health, including mental health, devoting maximum available resources to that end and guarding against retrogressive measures. The AAAQ framework provides the monitoring grid through which retrogression can be identified and measured: availability indicators, both structural indicators documenting the existence of a national mental health policy and legislation, and process indicators measuring workforce density, facility coverage and pharmaceutical supply, capture depletion and destruction of the conditions necessary for mental health. Accessibility indicators reveal exclusionary patterns across affected populations, requiring disaggregated data on who is reached rather than who is formally entitled. Acceptability indicators examine coercive practices, consent procedures and participation of affected communities in the design of care. Quality indicators assess continuity of care, clinical standards and the functioning of oversight mechanisms.Footnote 67 In this sense, the AAAQ framework functions not only as the normative content of the right to health, but as a person-centred accountability architecture.

Treaty bodies, special procedures and investigative bodies of the UN Human Rights Council, General Assembly and Security Council play a critical role in engaging substantively with the human right to health during armed conflict and in monitoring the human rights situation and violations against the normative framework of the right to health.Footnote 68 The UN SR Health, for instance, has made substantial contributions to the normative elaboration of the right to mental health, particularly through thematic reports addressing the social determinants of mental health, the prohibition on coercive practices, and the rights of persons with psychosocial disabilities.Footnote 69 Similarly, the Independent Expert on the Enjoyment of All Human Rights by Older Persons (IE HROP),Footnote 70 the Special Rapporteur on Torture, and Other Cruel, Inhuman or Degrading Treatment or Punishment (SR Torture)Footnote 71 and the Special Rapporteur on the Human Rights of Internally Displaced PersonsFootnote 72 have addressed dimensions of mental health in conflict settings, highlighting the multi-mandate relevance of the issue.

The CESCR, specifically, has repeatedly applied these legal obligations arising from the application of the AAAQ framework in its concluding observations on States affected by armed conflict, expressing concern, for instance, about the deterioration of mental health services in conflict-affected regions, and has called on those States to take immediate measures to restore and maintain minimum levels of mental health care.Footnote 73 Its observations confirm that minimum core obligations retain their operational force, even where full compliance is unattainable, and that States cannot invoke armed conflict as a categorical justification for the failure to provide access to essential mental health services.

Documenting mental health violations in armed conflict

The right to health framework allows a granular level of analysis that is capable of capturing differentiated realities. The same event may generate profoundly different consequences for the enjoyment of the right to mental health of children,Footnote 74 older persons, displaced persons, persons with disabilities, caregivers and marginalized communities.Footnote 75 The framework is also tailored to integrate into the analysis the gradual erosion of community support networks, the depletion of trained mental health workers,Footnote 76 the collapse of pharmaceutical supply chains and the steady deterioration of the social environments within which psychological resilience is either sustained or destroyed. Effectively safeguarding the right to mental health in armed conflict requires moving from incident-centred methodologiesFootnote 77 toward person-centred, disaggregated and longitudinal approaches, using human rights indicators and analytics that are capable of documenting these differentiated human rights impacts. Violations that remain invisible remain insufficiently addressed. Documentation and recording are central to protection and accountability.Footnote 78

One of the central challenges confronting human rights-based mental health protection globally is that violations remain under-reported and under-documented, partly as a result of the limited availability of comprehensive and disaggregated human rights-anchored data.Footnote 79 Humanitarian and public health systems generate data on mental health in conflict with regard to prevalence, service disruption, population exposure and biopsychosocial need, but the data and information collected and produced within these frameworks is not necessarily granular or specific enough to allow for an assessment of compliance with human rights obligations relating to the availability, accessibility, acceptability and quality of mental health services compliant with a human rights-based approach to mental health, the underlying determinants of the right to health, and the obligations of maximum available resources and non-retrogression. Data collection, by various actors, needs to be designed from the outset to measure compliance and potentially attribute legal responsibility in order for it to be of use for accountability initiatives, for instance by using human rights indicators.

Because of their operational requirements or strategic directions, different ecosystems prioritize different datasets serving distinct objectives. Some systems are designed to track trends over time,Footnote 80 others aim to support advocacy effortsFootnote 81 or generate data to guide operational responses, and some initiatives focus on accountability,Footnote 82 collecting material that can be used in legal proceedings at the national or international levels. These initiatives typically function in isolation, reflecting different mandates, conceptual frameworks, methodologies and reporting practices, which weakens efforts to ensure accountability for human rights violations.

The AAAQ framework under the right to health directs data collection and generates materially different consequences. The destruction of a mental health facility in conflict can be read simultaneously as a humanitarian emergency engendering the need for humanitarian assistance, a public health disruption requiring restoration of services, a violation of IHL attributable to one of the parties to the conflict, and a violation of the right to health of the affected individuals, requiring individual remedy. All of these framings may generate effective responses from each system’s perspective, but because the underlying methodologies do not prioritize human rights anchoring with the use of human rights indicators and data analytics, they do not necessarily allow for the assessment of human rights compliance. The human rights framing of documentation activates the full architecture of legal human rights obligation: the AAAQ dimensions, minimum core requirements, non-retrogression, the duty to use maximum available resources, and the procedural obligations of transparency, participation and accountability that underpin them.

Limited availability of human rights-anchored data continues to impede a full understanding of the degree to which the right to mental health is enjoyed in practice, thereby weakening accountability and evidence-based policy-making. In many contexts, available data and information remain fragmented, inconsistent or overly narrow in scope, focusing primarily on service utilization, prevalence estimates or institutional capacity while providing only limited insight into broader questions of equality, exclusion, discrimination, participation or accessibility.

The absence of adequate and timely data also constrains the ability of States and other actors to adopt responses that meaningfully address lived realities and differentiated risk levels from a human rights perspective. Without reliable information as to who is excluded from services, which populations experience disproportionate deterioration in mental health or how conflicts affect access to support systems over time, policies risk remaining generalized, reactive and insufficiently responsive to actual conditions on the ground.

These gaps become particularly pronounced in armed conflict, where data collection systems may be disrupted precisely when the need for human rights-anchored monitoring becomes most acute. Assessments tend to prioritize immediate and measurable indicators such as casualties, displacement figures, destruction of infrastructure and emergency needs, but while such approaches are indispensable, they may provide only limited understanding of the broader deterioration in the enjoyment of the right to mental health, also because such deterioration remains unevenly distributed across populations and continues long after immediate emergencies subside.Footnote 83 Without longitudinal and disaggregated monitoring, these dimensions frequently remain insufficiently visible within both humanitarian and accountability frameworks.

A human rights-based approach to data collection requires moving beyond narrow epidemiological or service-based models and toward more comprehensive qualitative and quantitative methodologies capable of capturing the social, institutional and relational dimensions of mental health.Footnote 84 Within a safeguarding framework, data collection and information should assess not only whether mental health services formally exist, but also whether they remain genuinely accessible, acceptable and effective for populations and communities affected by armed conflict. This requires examining patterns of exclusion, discriminatory barriers, resource allocation, institutionalization, continuity of care and the functioning of community-based support systems.

Disaggregation becomes indispensable in this regard. The same crisis may affect populations in fundamentally different ways depending on age, disability, socio-economic situation, ethnicity, displacement status, gender or geographic location. Without sufficiently granular data and information capable of capturing these differentiated realities, many risk factors remain statistically invisible and therefore insufficiently addressed within policy and recovery frameworks.Footnote 85 The absence of disaggregated data can itself constitute evidence of a failure to comply with the obligation to monitor, since the non-availability of information on relevant indicators may indicate a lack of commitment on the part of duty bearers to implement human rights.Footnote 86

The collection of data concerning the broader underlying determinants of mental health is equally important. Information relating to indicators on the erosion of social determinants such as access to food, clean water and sanitation, school enrolment/disruption rates, housing destruction and overcrowding, and livelihood loss rates, as well as data on health-care system functionality, may provide critical insight into the structural conditions shaping mental well-being and reveal intersecting forms of discrimination affecting persons engaging with mental health systems. In contemporary armed conflicts, evolving modes of warfare generate new and compounded biopsychosocial risk contexts, including large-scale environmental degradation, conflict-related pollution and the destruction of critical infrastructure, which intersect with other mental health challenges, such as climate anxiety,Footnote 87 that increasingly shape both risk factors and remedial measures, yet remain insufficiently captured within existing monitoring frameworks.

Documentation efforts cannot start only at the beginning of an armed conflict. Without pre-existing information concerning the degree of enjoyment of the right to mental health, it becomes exceedingly difficult to document and assess armed conflict-related deterioration, disproportionate impacts or recovery trajectories over time. Baseline studies, grounded in the AAAQ framework, play a critical role in identifying structural weaknesses before crises escalate, and in enabling more accurate assessment of progress towards the attainment of rights. The recent call by the UN Human Rights Council for a baseline study of the current state of the realization of the human rights of persons with psychosocial disabilities and current or potential users of mental health servicesFootnote 88 reflects this concern and the recognition that continuous human rights monitoring architectures are essential for prevention, accountability and recovery.

Where a State has failed to develop indicators and benchmarks for the right to health prior to a crisis, that failure may itself constitute a violation of the obligation to fulfil, since monitoring the nationwide realization of the right through indicators and benchmarks is an obligation under the ICESCR.Footnote 89 The CESCR has formulated the so-called IBSA procedure – (1) the identification human rights indicators, (2) the setting of benchmarks, (3) a process of scoping, and (4) periodic assessment – as the operational mechanism through which States demonstrate progressive compliance with their right to health obligations over successive reporting cycles.Footnote 90

A human rights-based approach also requires that data collection itself be conducted consistently with human rights principles; participation is therefore essential. Organizations representing persons with psychosocial disabilities, users of mental health services, minority communities and other affected groups should be meaningfully implicated in the design, implementation and interpretation of monitoring systems.

A critical element towards the strengthening of data systems and evidence for the protection of the right to mental health in conflict is a better understanding of how different data collection systems operate and interact, and to enhance coordination and data sharing in order to better protect health care in conflict settings.Footnote 91 Interoperability is foremost a conceptual questionFootnote 92 – it requires that different systems, such as humanitarian, health and human rights systems, build a shared understanding of what the data and information is capturing and documenting and enhance their cooperation on the sharing of qualitative and quantitative data in order to integrate complementary sources of information. This does not require reciprocal substitution, meaning that humanitarian or health systems turn into human rights mechanisms; rather, it requires each system to recognize that its operations are embedded within a legal framework and that the right to health provides a shared normative basis.

In practical terms, this means that humanitarian needs assessments should be structured to capture AAAQ dimensions and document patterns of exclusion and discrimination as well as aggregate needs. Public health monitoring systems in conflict should collect disaggregated, longitudinal data on the structural determinants of mental health as well as on service coverage and clinical outcomes. Human rights documentation methodologies, moreover, should be designed to incorporate and legally frame the data produced by humanitarian and health systems, rather than operating as a parallel and disconnected documentation stream.

The normative foundation for this interoperability already exists. The right to health framework, the interpretive elaborations of treaty bodies and the methodological contributions of Special Procedures and investigative bodies can together provide the required minimum legal and conceptual basis. There is a growing opportunity to strengthen institutional investment and galvanize political will to adopt this framework as a shared language for mental health accountability across the full landscape of actors and systems engaged in conflict response.

Ultimately, safeguarding the right to mental health requires understanding data and information not simply as a technical tool of measurement but as an essential component of visibility, accountability and protection. What remains undocumented – and thus invisible – frequently remains politically marginalized and insufficiently addressed. Conversely, more comprehensive, disaggregated and human rights-anchored monitoring systems can contribute to stronger and informed policy responses, and to making visible the lived realities, inequalities and structural barriers that continue to shape the enjoyment of the right to the highest attainable standard of physical and mental health before, during and after armed conflicts.

Conclusion

Armed conflict does not suspend the right to mental health. The international human rights framework establishes obligations that are specific enough to guide practice, sufficiently robust to generate accountability, and flexible enough to apply in the conditions of constraints generated by armed conflict.Footnote 93

The continued applicability of the right to health, across conflict, recovery and peace contexts, constitutes one of its defining strengths as a safeguarding framework. Right to health obligations apply before conflict begins, requiring States to build and maintain mental health systems capable of withstanding crisis and to address pre-existing inequalities that will determine how populations experience violence when it arrives.Footnote 94 These obligations apply during conflict, requiring continuity of health care, protection of mental health workers and infrastructure, and integration of mental health into emergency response. They also apply after hostilities cease, requiring recovery that rebuilds facilities as well as the community structures, trust and social conditions through which psychological resilience re-emerges. This three-stage structure means that right to health obligations can generate State responsibility across the entirety of the cycle, including for the cumulative, long-term erosion of mental health that frequently remains insufficiently addressed.

Such an approach of safeguarding the right to mental health offers a complementary, comprehensive, preventive, human rights-based and operationally sustainable framework. It enables analysis not only of direct violence and attacks, but also of underlying determinants of health, inequalities, discrimination, austerity, displacement, uncertainty, conflict- and climate-related trauma and long-term consequences.Footnote 95 It also permits engagement far beyond traditional armed conflict settings.

What is required is the practical concretization and effective application of the existing standards, a task to which treaty bodies, Special Procedures, investigative bodies and those engaged in human rights practice are each contributing, but which demands greater collaboration, cooperation, coherence and systematic attention. Key to the operational translation of those standards is the elaboration of monitoring methodologies anchored in the AAAQ framework, and in the recognition, across all systems engaged in conflict response, that affected persons are rights holders, that States are duty bearers, and that failure to protect the enjoyment of the right to mental health and ensure non-discriminatory access to mental health systems may constitute a human rights violation engaging legal responsibility.

Failing to address the mental health consequences of armed conflict has consequences which extend across generations. Giving full legal effect to the right to mental health in conflict is both an imperative under international human rights law and a precondition for the rebuilding of societies on which sustainable peace depends.

Footnotes

*

The views expressed in this paper are those of the author and do not necessarily reflect the views of the United Nations secretariat or any other organization with which the author was previously affiliated (ST/IC/2006/30, paras 7–9).

The advice, opinions and statements contained in this article are those of the author/s and do not necessarily reflect the views of the ICRC. The ICRC does not necessarily represent or endorse the accuracy or reliability of any advice, opinion, statement or other information provided in this article.

References

1 Volker Türk, “Safeguarding the Right to Health in Crisis”, in Ilona Kickbusch and John Kirton (eds), Health: A Political Choice: The Future of Health in a Fractured World, Global Governance Project, 2025, p. 90.

2 International Committee of the Red Cross, Health Care in Danger: Respecting and Protecting Health Care in Armed Conflict and Other Situations of Violence, 31IC/11/5.3.1, Geneva, October 2011, Annex I; UNSC Res. 2286, 3 May 2016. Several United Nations (UN) General Assembly resolutions include references to the right to health in conflict: see, in particular, UNGA Res. 68/101, 13 December 2013, para. 24; UNGA Res. 69/132, “Global Health and Foreign Policy”, 11 December 2014; Comprehensive Report on Access to Medicines, Vaccines and Other Health Products in the Context of the Right to the Highest Attainable Standard of Physical and Mental Health: Report of the Office of the United Nations High Commissioner for Human Rights, UN Doc. A/HRC/59/29, 7 April 2025 (Comprehensive Report on Access to Medicines), paras 43–44, 71(b); HRC Res. 59/7, 7 July 2025, preambular para. 55 (renewing the triennial mandate on mental health).

3 Victoria Williamson and Dominic Murphy, “Psychological Consequences of Global Armed Conflict”, BMC Psychology, Vol. 13, 2025; Fiona Charlson et al., “New WHO Prevalence Estimates of Mental Disorders in Conflict Settings: A Systematic Review and Meta-Analysis”, The Lancet, Vol. 394, No. 10194, 2019.

4 See the articles by Giulia Bosi and Emily Camins in this issue of the Review: Giulia Bosi, “Mental Health in Conflict and Post-Conflict Settings: An Analysis of UN Human Rights Treaty Bodies’ Concluding Observations”, International Review of the Red Cross, Vol. 108, No. 932, 2026; Emily Camins, “Supporting Mental Health in Post-Conflict Situations: Examining the Intersection of Human Rights Obligations and Victim Assistance Frameworks”, International Review of the Red Cross, Vol. 108, No. 932, 2026. On the ongoing drafting of a new General Comment on economic, social and cultural rights in the context of armed conflicts, see Committee on Economic, Social and Cultural Rights (CESCR), Report on the Seventy-First and Seventy-Second Sessions, UN Doc. E/2023/22-E/C.12/2022/3, 22 February 2023, para. 96.

5 Comprehensive Report on Mental Health and Human Rights: Report of the United Nations High Commissioner for Human Rights, UN Doc. A/HRC/58/38, 14 January 2025 (Comprehensive Report on Mental Health), para. 5; Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health [SR Health], UN Doc. A/78/185, 14 July 2023; Report of the SR Health, UN Doc. A/HRC/41/34, 12 April 2019; Hanna Kienzler, “Mental Health in All Policies in Contexts of War and Conflict”, The Lancet Public Health, Vol. 4, No. 11, 2019.

6 Omar S. Rasheed, statement at the Office of the UN High Commissioner for Human Rights (OHCHR) consultation to examine key challenges and opportunities for advancing a human rights-based approach to mental health, 23 October 2024, available at: www.ohchr.org/sites/default/files/documents/issues/health/consultation/mentalhealthoct2024/openingstat/ICRC-Key-points.pdf (all internet references were accessed in July 2026).

7 Report of the SR Health, UN Doc. A/68/297, 9 August 2013, paras 8, 25, noting that armed conflict disrupts underlying determinants of health and that interruption of treatment and lack of psychosocial services can be especially detrimental to mental health; CESCR, Concluding Observations on the Seventh Periodic Report of the Russian Federation, UN Doc. E/C.12/RUS/CO/7, 23 October 2025, para. 4.

8 Regarding the conceptual approach by the OHCHR, with further references, see OHCHR, “Safeguarding the Right to Health in Crisis”, available at: www.ohchr.org/en/health/safeguarding-right-health-crisis.

9 CESCR, General Comment No. 14, “The Right to the Highest Attainable Standard of Health”, UN Doc. E/C.12/2000/4, 11 August 2000 (General Comment 14), para. 11.

10 International Covenant on Economic, Social and Cultural Rights, 993 UNTS 3, 16 December 1966 (entered into force 3 January 1976) (ICESCR), Art. 12: “1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.”

11 The term “biopsychosocial” refers to three interconnected dimensions that shape health outcomes: biological factors, psychological factors and social factors. Sravya Palla et al., “Evaluation of the Biopsychosocial Model of Health among Emerging Adults”, BMC Psychology, Vol. 13, No. 1, 2025, p. 2; see also Biopsychosocial Factors Conducive to Torture and Ill-Treatment: Interim Report of the Special Rapporteur on Torture, and Other Cruel, Inhuman or Degrading Treatment or Punishment [SR Torture], UN Doc. A/75/179, 20 July 2020, para. 5(a).

12 General Comment 14, above note 9, para. 34.

13 Comprehensive Report on Mental Health, above note 5, para. 59.

14 Convention on the Rights of the Child, 1577 UNTS 3, 20 November 1989 (entered into force 2 September 1990), Art. 24.

15 Convention on the Elimination of All Forms of Discrimination against Women, 1249 UNTS 13, 18 December 1979 (entered into force 3 September 1981), Art. 12.

16 Convention on the Rights of Persons with Disabilities, 2515 UNTS 3, 13 December 2006 (entered into force 3 May 2008) (CRPD), Arts 11, 12, 25.

17 Ibid., Art. 25.

18 Comprehensive Report on Mental Health, above note 5, para. 5.

19 Article 4(2) of the ICCPR sets out that no derogation can be made from Articles 6, 7, 8(1)–(2), 11, 15, l6 and l8; derogations under strictly limited conditions can be made from other Covenant provisions. International Covenant on Civil and Political Rights, 999 UNTS 171, 16 December 1966 (entered into force 23 March 1976) (ICCPR), Art. 4(2). For information on derogable civil and political rights and the conditions under which this is possible, see Committee on Civil and Political Rights, General Comment No. 29, “Article 4: Derogations during a State of Emergency”, UN Doc. CCPR/C/21/Rev.1/Add.11, 24 July 2001.

20 OHCHR, International Legal Protection of Human Rights in Armed Conflict, HR/PUB/11/01, 2011, available at: www.ohchr.org/sites/default/files/Documents/Publications/HR_in_armed_conflict.pdf; Protection of Economic, Social and Cultural Rights in Conflict: Report of the United Nations High Commissioner for Human Rights, UN Doc. E/2015/59, 19 May 2015, para. 12.

21 CESCR, General Comment No. 3, “The Nature of States Parties’ Obligations”, UN Doc. E/1991/23, 14 December 1990 (General Comment 3), paras 1–10; General Comment 14, above note 9, paras 30–47.

22 CRPD, above note 16, Art. 1: “Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.” See also Gauthier de Beco, “Taking Economic and Social Rights Earnestly: What Does International Human Rights Law Offer Persons with Disabilities in Situations of Armed Conflict?”, International Review of the Red Cross, Vol. 105, No. 922, 2023, p. 314.

23 CRPD, above note 16, Art. 11.

24 See Andrew Begg, “From Invisibility to Positive Legal Protection: The Drafting of Article 11 of the Convention on the Rights of Persons with Disabilities”, International Review of the Red Cross, Vol. 105, No. 922, 2023, on the travaux préparatoires for CRPD Article 11.

25 Andrew Clapham, “Human Rights in Armed Conflict: Metaphors, Maxims, and the Move to Interoperability”, in Human Rights and International Legal Discourse, Vol. 12, No. 1, 2018, p. 19, with further references; see also Andrew Clapham, “The Complex Relationship between the 1949 Geneva Conventions and International Human Rights Law”, in Andrew Clapham, Paola Gaeta and Marco Sassòli (eds), The 1949 Geneva Conventions: A Commentary, Oxford University Press, Oxford, 2015.

26 ICJ, Legal Consequences of the Construction of a Wall in the Occupied Palestinian Territory, Advisory Opinion, ICJ Reports 2004, p. 136, paras 111–113; ICJ, Armed Activities on the Territory of the Congo (Democratic Republic of the Congo v. Uganda), Judgment, ICJ Reports 2005, p. 168, para. 216.

27 ICJ, Legal Consequences Arising from the Policies and Practices of Israel in the Occupied Palestinian Territory, including East Jerusalem, Advisory Opinion, ICJ Reports 2024, para. 99.

28 CESCR, Concluding Observations on the Fourth Periodic Report of Israel, UN Doc. E/C.12/ISR/CO/4, 12 November 2019, para. 9; CESCR, Concluding Observations on the Third Periodic Report of Yemen, UN Doc. E/C.12/YEM/CO/3, 6 November 2023, para. 6; UN Doc. E/C.12/RUS/CO/7, above note 7, paras 4–5; CESCR, Concluding Observations on the Fourth Periodic Report of Azerbaijan, UN Doc. E/C.12/AZE/CO/4, 2 November 2021, para. 6; CESCR, Concluding Observations on the Initial Report of the Central African Republic, UN Doc. E/C.12/CAF/CO/1, 4 May 2018, paras 8–9.

29 Report of the SR Health, UN Doc. A/HRC/41/34, 12 April 2019, para. 1.

30 WHO and OHCHR, Mental Health, Human Rights and Legislation: Guidance and Practice, 2023 (Mental Health Guide), pp. 1, xvii, 12; see also Report of the Special Rapporteur on the Rights of Persons with Disabilities, UN Doc. A/76/146, 19 July 2021, paras 8–10.

31 WHO and OHCHR, above note 30, Section 2.5.6 (on implementation in humanitarian contexts and emergencies).

32 Alexander Breitegger, “Increasing Visibility of Persons with Disabilities in Armed Conflict: Implications for Interpreting and Applying IHL”, International Review of the Red Cross, Vol. 105, No. 922, 2023, pp. 116–117.

33 Torture and Ill-Treatment in Healthcare Settings: Report of the SR Torture, UN Doc. A/HRC/22/53, 1 February 2013, para. 48.

34 Report of the SR Health, UN Doc. A/HRC/35/21, 28 March 2017, paras 16–22.

35 UN Doc. A/HRC/22/53, above note 33, para. 70.

36 See the article by Dick Clomen in this issue of the Review: Dick Clomen, “Affirming and Advancing International Standards for Meeting Mental Health and Psychosocial Needs: Resolution 2 of the 33rd International Conference”, International Review of the Red Cross, Vol. 108, No. 932, 2026.

37 See 33rd International Conference, Res. 33IC/19/R2, “Addressing Mental Health and Psychosocial Needs of People Affected by Armed Conflicts, Natural Disasters and Other Emergencies, 2019, and its progress report of September 2024 (34IC/24/10.2); see also HRC Res. 52/12, “Mental Health and Human Rights”, 14 April 2023.

38 See UNHCR, “Mental Health and Psychosocial Support”, available at: www.unhcr.org/what-we-do/protect-human-rights/public-health/mental-health-and-psychosocial-support, with further references; Executive Committee of the High Commissioner’s Programme, Conclusion No. 116 (LXXIII) “Mental Health and Psychosocial Support”, 2022.

39 World Health Assembly, Res. WHA77.3, “Strengthening Mental Health and Psychosocial Support before, during and after Armed Conflicts, Natural and Human-Caused Disasters and Health and Other Emergencies”, 1 June 2024.

40 HRC Res. 61/18, “Mental Health and Human Rights”, 30 March 2026; see also Political Declaration of the Fourth High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and Well-Being, UNGA Res. 80/117, 15 December 2025, para. 21, with explicit reference to those in conflict bearing a disproportionate burden of mental health conditions.

41 General Comment 14, above note 9, para. 12.

42 Ibid., para. 12; see also Committee on the Rights of the Child, General Comment No. 15 (2013), “The Right of the Child to the Enjoyment of the Highest Attainable Standard of Health”, UN Doc. CRC/C/GC/15, 17 April 2013, paras 24–25, 29, 31, 36–40, 112–116; Mental Health and Human Rights: Report of the High Commissioner, UN Doc. A/HRC/34/32, 31 January 2017, para. 9; OHCHR and WHO, “The Right to Health”, Fact Sheet No. 31, 2008, p. 4.

43 CESCR, Concluding Observations on the Fifth Periodic Report of Iraq, UN Doc. E/C.12/IRQ/CO/5, 14 March 2024, para. 46.

44 General Comment 14, above note 9, para. 12(a)–(d); UN Doc. E/C.12/YEM/CO/3, above note 28, para. 5; UN Doc. E/C.12/CAF/CO/1, above note 28, para. 8.

45 OHCHR, Analytical Study on Key Challenges in Ensuring Access to Medicines, Vaccines and Other Health Products in the Context of the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, UN Doc. A/HRC/56/28, 17 July 2024, paras 37–41; see also Report of the SR Health, UN Doc. A/68/297, 9 August 2013, para. 25.

46 Report of the SR Health, UN Doc. A/HRC/41/34, 12 April 2019, paras 5–6.

47 OHCHR, Report on the Human Rights Situation in Ukraine: 1 September–30 November 2024, 31 December 2024, para. 21 and fn. 5; Comprehensive Report on Mental Health, above note 5, para. 43.

48 OHCHR, Thematic Study on the Rights of Persons with Disabilities under Article 11 of CRPD, on Situations of Risk and Humanitarian Emergencies, UN Doc. A/HRC/31/30, 30 November 2015, paras 41–42; Mario Lopez Alba, statement at the OHCHR consultation on 23 October 2024 to examine key challenges and opportunities for advancing a human rights-based approach to mental health, available at: www.ohchr.org/sites/default/files/documents/issues/health/consultation/mentalhealthoct2024/openingstat/Mario-Lopez-MSF.docx.

49 Report of the Special Rapporteur on the Human Rights of Internally Displaced Persons, UN Doc. A/76/169, 16 July 2021, paras 44, 63; Khaled Hassine, Handling Climate Displacement, Cambridge University Press, Cambridge, 2022, pp. 106–109, 124–131; Khaled Hassine, “Coping with Climate Change: A Critical Review of the Link between the Human Rights System and Climate Displacement”, in Simon Behrman and Avidan Kent (eds), Climate Refugees: Global, Local and Critical Approaches, Cambridge University Press, Cambridge, 2022, pp. 335–336.

50 Report of the Special Rapporteur on Minority Issues, UN Doc. A/71/254, 29 July 2016, paras 54–66.

51 General Comment 14, above note 9, para. 12(b).

52 UN Doc. E/2015/59, above note 20, paras 36, 54; Report of the SR Health, UN Doc. A/68/297, 9 August 2013, paras 11–12.

53 A. Breitegger, above note 32, pp. 116–117.

54 General Comment 14, above note 9, para. 12(d); Report of the SR Health, UN Doc. A/68/297, 9 August 2013, para. 11.

55 For a detailed discussion on minimum core obligations, see e.g. E. Camins, above note 4.

56 UN Doc. E/C.12/YEM/CO/3, above note 28, para. 5; UN Doc. E/C.12/CAF/CO/1, above note 28, para. 8.

57 General Comment 14, above note 9, paras 43–44.

58 Ibid., para. 45.

59 Ibid., para. 43.

60 Ibid., paras 18–19; CESCR, General Comment No. 20, “Non-Discrimination in Economic, Social and Cultural Rights”, UN Doc. E/C.12/GC/20, 2 July 2009, para. 7.

61 ICESCR, above note 10, Art. 2(1); General Comment 14, above note 9, para. 32.

62 General Comment 3, above note 21, para. 9. See also Report of the Commission on Human Rights in South Sudan, UN Doc. A/HRC/60/CRP.5, 16 September 2025, paras 26(b), 27 (noting that the diversion of funds and failure to prioritize the right to health is a violation of Article 12 of the ICESCR).

63 OHCHR, above note 20, paras 26–29; OHCHR, A Human Rights-Based Approach to Data: Leaving No One Behind in the 2030 Agenda for Sustainable Development, Geneva, 2018, pp. 18–19.

64 General Comment 14, above note 9, paras 47, 53–54.

65 General Comment 3, above note 21, paras 9–13.

66 General Comment 14, above note 9, para. 44.

67 OHCHR, Human Rights Indicators: A Guide to Measurement and Implementation, HR/PUB/12/5, New York and Geneva, 2012, pp. 33–38.

68 See Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel, UN Doc. A/79/232, 11 September 2024, paras 6–26, 30–40; Reports of the Commission on Human Rights in South Sudan, UN Doc. A/HRC/61/25, 19 February 2025, paras 41, 44, 61, 63; UN Doc. A/HRC/60/CRP.5, 16 September 2025, paras 27–224; and UN Doc. A/HRC/58/27, 28 February 2025, paras 59–61; Reports of the Independent International Fact-Finding Mission for the Sudan, UN Doc. A/HRC/61/77, 17 February 2026, paras 26–28, 62; UN Doc. A/HRC/60/22, 22 September 2025, paras 88–98, 102; UN Doc. A/HRC/57/CRP.6, 23 October 2024, paras 203–218; and UN Doc. A/HRC/57/23, 7 November 2024, paras 46–48, 64, 85; Report of the Independent International Commission of Inquiry on the Syrian Arab Republic, UN Doc. A/HRC/55/64, 9 February 2024, paras 26, 71, 99; Report of the OHCHR Investigation on Sri Lanka, UN Doc. A/HRC/30/CRP.2, 16 September 2015, paras 866–872, 1002–1022, with multiple references to the impact of attacks on the right to health and disruptions to the health-care system constituting violations of the right to health. For other reports, see UN Doc. E/2015/59, above note 20, paras 43–45; see also Report of the SR Health, UN Doc. A/68/297, 9 August 2013, which considers the right to health obligations of States and non-State actors towards persons affected by and/or involved in conflict situations (see e.g. paras 26–29, 35–40).

69 Report of the SR Health, UN Doc. A/HRC/41/34, 12 April 2019, paras 10–14.

70 Older Persons in Armed Conflict and Peacebuilding: Report of the IE HROP, UN Doc. A/80/203, 18 July 2025, paras 35, 49; Human Rights of Older Persons in the Context of Climate Change-Induced Disasters: Report of the IE HROP, UN Doc. A/78/226, 25 July 2023, paras 59–60, 69, 92.

71 Report of the SR Torture, UN Doc. A/79/181, 18 July 2024, paras 17, 26, 50, 52; Country Visit Ukraine: Report of the SR Torture, UN Doc. A/HRC/55/52/Add.1, 20 March 2024, para. 86.

72 Report of the Special Rapporteur on the Human Rights of Internally Displaced Persons, UN Doc. A/80/212, 21 July 2025, para. 10.

73 CESCR, Concluding Observations on the Fourth Periodic Report of Iraq, UN Doc. E/C.12/IRQ/CO/4, 27 October 2015, para. 48; CESCR, Concluding Observations on the Initial Report of Yemen, UN Doc. E/C.12/YEM/CO/2, 30 June 2011, para. 26; CESCR, Concluding Observations on the Seventh Periodic Report of Colombia, UN Doc. E/C.12/COL/CO/7, 20 October 2025, paras 44–45(e); UN Doc. E/C.12/IRQ/CO/5, above note 43, para. 46; CESCR, Concluding Observations on the Initial Report of Mali, UN Doc. E/C.12/MLI/CO/1, 6 November 2018, para. 45.

74 Rochelle L. Frounfelker et al., “Living through War: Mental Health of Children and Youth in Conflict-Affected Areas”, International Review of the Red Cross, Vol. 101, No. 911, 2019, pp. 483–486.

75 Older Persons in Armed Conflict and Peacebuilding: Report of the IE HROP, UN Doc. A/80/203, 18 July 2025; Human Rights of Older Persons in Emergency Situations: Report of the IE HROP, UN Doc. A/HRC/42/43, 4 July 2019, para. 65; Marie Louise D. Østergaard et al., “Vulnerability Factors in Conflict-Related Mental Health”, Medicine, Conflict and Survival, Vol. 39, No. 1, 2023, pp. 6–10.

76 OHCHR, above note 20, para. 38.

77 Benjamin Mason Meier, Hannah Rice and Shashika Bandara, “Monitoring Attacks on Health Care as a Basis to Facilitate Accountability for Human Rights Violations”, Health and Human Rights Journal, Vol. 23, No. 1, 2021, pp. 62–64; WHO, Surveillance of Attacks on Health Care: Methodology and Implementation, WHO/WHE/EMO/2010/2019.2/BRO, Geneva, December 2018.

78 Comprehensive Report on Access to Medicines, above note 2, para. 43.

79 See also The Data Gap Conundrum: Report of the IE HROP, UN Doc. A/HRC/45/14, 9 July 2020, on how this affects older persons (see e.g. paras 72–78).

80 See e.g. WHO’s Surveillance System for Attacks on Healthcare, available at: https://extranet.who.int/ssa/Index.aspx.

81 See e.g. the Safeguarding Health in Conflict Coalition, available at: https://safeguarding-health.com/.

82 See e.g. Insecurity Insight’s Security in Numbers Database, available at: https://insecurityinsight.org/.

83 Report of the SR Health, UN Doc. A/68/297, 9 August 2013, para. 37; Report of the Special Rapporteur on the Rights of Persons with Disabilities, UN Doc. A/76/146, 2021, 19 July 2021, para. 30; UN Office for the Coordination of Humanitarian Affairs, Breaking the Impasse: Reducing Protracted Internal Displacement as a Collective Outcome, 2017, pp. 34, 48, 106, 127.

84 OHCHR, A Human Rights-Based Approach to Data, above note 63, pp. 3, 7.

85 Ibid., pp. 7–10; Human Rights of Older Persons in Emergency Situations: Report of the IE HROP, UN Doc. A/HRC/42/43, 4 July 2019, paras 44–48; Brandon Hamber, Transitional Justice, Mental Health and Psychosocial Support: Renewing the United Nations Approach to Transitional Justice, 28 September 2021, pp. 6–8, available at: www.ohchr.org/sites/default/files/documents/issues/transitionaljustice/sg-guidance-note/SG-GuidanceNote-TJ-Mental-Health-digital.pdf.

86 OHCHR, above note 67, pp. 127 and 40, Fig. VI.

87 Special Rapporteur on Climate Change and Human Rights, submission to the OHCHR call for contributions on mental health and human rights (HRC Res. 52/12), 14 January 2025, available at: www.ohchr.org/sites/default/files/documents/issues/health/cfis/mental-health/subm-mental-health-hr-un-enti-un-sr-climate-change.docx.

88 HRC Res. 61/18, above note 40, para. 20, requesting a comprehensive report, including a baseline study on the realization of the human rights of persons with psychosocial disabilities and users of mental health services, gathering lived experiences and providing policy tools for implementation.

89 General Comment 14, above note 9, para. 43(f).

90 Ibid., paras 57–58; OHCHR, above note 67, pp. 104–108; Eibe Riedel, The IBSA Procedure as a Tool of Human Rights Monitoring, University of Mannheim and FIAN International, 2006.

91 See, for instance, the recent initiative by the OHCHR (HRC Res. 61/18, above note 40), the Researching the Impact of Attacks on Healthcare Consortium, the World Innovation Summit for Health, and the International Federation of the Red Cross and Red Crescent Societies workshop on “Strengthening Data Systems and Evidence for the Protection of the Right to Health and Healthcare in Conflict”. OHCHR, “Safeguarding the Right to Health in Crisis”, available at: www.ohchr.org/en/health/safeguarding-right-health-crisis. See also HRC Res. 62/20, 7 July 2026, op. para. 13(m), (p).

92 Hanna Kienzler, “Mental Health in All Policies in Contexts of War and Conflict”, The Lancet Public Health, Vol. 4, No. 11, 2019, pp. 547–548.

93 See e.g. Kathryn Sikkink, Evidence for Hope: Making Human Rights Work in the 21st Century, Princeton University Press, Princeton, NJ, and Oxford, 2017, providing empirical evidence of long-term progress in human rights compliance.

94 See Committee on the Rights of Persons with Disabilities, Concluding Observations on Combined Second and Third Periodic Reports of Ukraine, UN Doc. CRPD/C/UKR/CO/2-3, 2 October 2024, para. 22; Rohini Haar, statement at the side event of the 61st Session of the Human Rights Council, “Mental Health: From Rights to Reality”, 23 March 2026, available at: www.ohchr.org/sites/default/files/documents/issues/health/consultation/rights-reality/20260323-hrc61-se-mental-health-panelist-interventions.pdf.

95 WHO and OHCHR, above note 30, p. 10; Doron Amsalem et al., “The Effects of War-Related Experiences on Mental Health Symptoms of Individuals Living in Conflict Zones: A Longitudinal Study”, Scientific Reports, Vol. 15, 2025.