Roads to Regulation: A Discussion on Non-State Armed Groups' International Health Law Obligations

Non-state actors can look and operate like governments, yet without formal statehood, they exist in a regulatory gray area. Non state actors play an increasingly influential role in international law, yet they remain largely unregulated. This paper examines non-state actors as a class, with particular attention to non-State armed groups (NSAGs), and analyzes the regulatory gap they occupy specifically within international health law. The paper first surveys the rise, diversity, authority, and legitimacy of non-state actors in relation to States, highlighting their growing involvement in governance functions traditionally reserved for States. This paper then introduces the World Health Organization (WHO) and the International Health Regulations (IHR) as the central framework governing global health emergencies, emphasizing that these legally binding obligations apply exclusively to WHO Member States. Lacking formal statehood, nonstate actors lack the legitimacy undergirding UN Member States' international obligations. Through an analysis of WHO's Framework for Engagement with Non-State Actors (FENSA) and its partnership with the International Federation of the Red Cross (IFRC), the paper demonstrates both the benefits and the limitations of existing engagement mechanisms, noting that WHO's narrow definition of non-state actors excludes NSAGs and leaves populations under their control beyond the reach of international health regulation.