Global health researchers, UN agencies, and donors have become expert at documenting the deterioration of population health during conflict, yet documentation has not stopped that deterioration. Drawing on 15 years of field research in Syria, Lebanon, Gaza, and Jordan, we argue that part of the failure of the global health architecture stems not principally from violations of international humanitarian law, but from its design as a technical enterprise detached from the political economy of power, financing, and governance. In practice, the system was structured to document harm rather than to hold anyone accountable for it. We distinguish humanitarian neutrality, understood as the operational duty to assist all civilians, from technical neutrality, which excludes political accountability in ways that protects institutional relationships and funding. We define a political economy of health approach, identify specific actors capable of changing the system, and acknowledge both the real, although uneven, effects of documentation and the structural constraints, namely sovereignty, donor dependence, and entrenched interests, that any reform should confront. Finally, we propose six concrete shifts to move global health from monitoring harm and misery towards enabling accountability.
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