A/68/297 forced into silence and excluded from their communities. 75 The impact of sexual violence on the mental health of survivors, as well as their family and community may endure for generations. 76 Sexual violence also compromises the participation of targeted communities in public health efforts long after conflict has ended. 50. Parties to conflict may also use health services as a strategy to target specific communities. Parties may deliberately deny humanitarian aid and health services to certain individuals or communities based on their ethnic, religious or political affiliation. 77 Destruction of underlying determinants of health, such as by poisoning wells and burning farmland, is another strategy that may deny affected communities a life of dignity and well-being. 78 Such strategies may undermine the ability of targeted groups to respond to serious health needs. 79 Groups thus targeted may be unable to access nutritious food, hygiene or medical care, which may prevent them from enjoying their right to health. They may also be excluded from participation in democratic decision-making, including decisions on health services, which may perpetuate health inequities in post-conflict settings. V. Obligations of entities other than the primary State 51. The primary responsibility for realizing the right to health in conflict lies with States who are involved in the conflict. However, other States and non-State actors, including armed groups, international organizations and humanitarian non-governmental organizations, also bear obligations towards the realization of the right to health of affected populations. A. International obligations 52. According to the International Covenant on Economic, Social and Cultural Rights, all States have an obligation to take steps, individually and through international cooperation and assistance, towards the full realization of economic, social and cultural rights, including the right to health. To comply with their international obligations, States must respect the right to health of populations in other countries, protect against violations by third parties where they are able to influence those third parties through legal or political means, and facilitate access to essential health services in other countries, depending on the availability of resources. In particular, States have an obligation to provide humanitarian aid in disasters and emergencies, including conflict and post-conflict situations. __________________ 75 76 77 78 79 13-42297 WHO, “Rape: how women, the community and the health sector respond” (Geneva, 2007). Available from www.svri.org/rape.pdf, pp. 12-14; Nadera Shalhoub-Kevorkian, “Towards a cultural definition of rape”, Women’s Studies International Forum, vol. 22, No. 2 (March/April 1999), pp. 165-166. Colleen Kivlahan and others, “Rape as a weapon of war in modern conflicts”, British Medical Journal, vol. 340, No. 3270 (June 2010), pp. 468-469. MSF, “Syria: medicine as a weapon of persecution” (New York, 2012). PHR, Darfur: Assault on Survival: A Call for Security, Justice and Restitution (Washington, D.C., 2006), pp. 37-38. Ibid. 17/24