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Nguyen Ha Linh
Nguyen Ha Linh

A young woman living in Vietnam has called on organizations and communities locally and globally to step up support for people living with noncommunicable diseases (NCDs) – especially multiple sclerosis (MS).

“I call on the Vietnamese government to give economic support packages to people living with NCDs, especially people with disabilities, because many are paralyzed, unable to support themselves and earn a living,” said Nguyen Ha Linh.

Ha Linh lives with MS. Since the age of 23 she has been rapidly deteriorating. While at first she worked as a graphic designer, gradually her arms and legs weakened until she became paralyzed. She developed atrophy of the nerve in her eyes. Today, all of her activities depend on the care of her relatives.

Nguyen Ha Linh
Nguyen Ha Linh

Access to care

But her greatest challenges have been access to care and finances.

“Multiple sclerosis is not covered by insurance in Vietnam, so I must pay for my care out of pocket, with financial support from my relatives,” Ha Linh explained. “Multiple sclerosis is considered a rare disease in Vietnam. People living with this condition find it very difficult to access diagnosis and care, and not all major hospitals have the resources for treatment. For those that manage to access care for multiple sclerosis, this is very expensive.”

Government must take action

She said that people living with MS often focus on getting funding from philanthropists who care about people living with disabilities. However, she believes that the government should be the one to take action first.

“Many challenges related to treatment, care and support for people living with NCDs remain largely unaddressed,” Ha Linh said. “In particular, the components of care and support are weak, which therefore means that relatives play an important role for those who have a good support system at home. This is not always the case.

“People living with NCDs would like to call on the government to change the regulations around health insurance to allow access to affordable diagnostics and care to help us have a better life,” she concluded.

Read Nguyen Ha Linh’s full NCD Diary.
Read next post.

Image Credits: Courtesy of the NCD Alliance.

women

Women and girls are more at risk of getting killed at home by intimate partners or family. A new report by UN Women and the UN Office on Drugs and Crimes (UNODC) said that more than five women or girls are killed every hour across the world by their partners or families. 

The report, released ahead of the UN’s International Day for the Elimination of Violence Against Women on Friday, said that while men are subjected to higher rates of homicides across the world, women and girls are disproportionately affected by higher rates of homicides in private spaces.

In 2021, 81,000 women and girls were killed intentionally, of which around 45,000 – some 55% – were killed by their own intimate partners or family members. By comparison, 11% of the total male homicides happened in private spaces. 

Covid-19 huge push to fatal violence against women

The report found mixed trends on femicide across the world. 

Between 2010 and 2021, the total number of female homicides by intimate partners or families fell by 19% in Europe. But that number rose by 6% in the Americas overall even as South America reported a decrease.

COVID-19 and the subsequent confinement to homes seems to have led to an increase in gender-related killings of women and girls in North America, Western and Southern Europe in 2020, according to the report.

“Other sub-regions in Europe and the Americas recorded negligible changes or decreases in the number of killings between 2019 and the end of 2020, which suggests that the onset of the COVID-19 pandemic had heterogeneous impacts,” it said. “The decreases in some sub-regions may reflect delays in recording due to COVID-19 rather than reductions in the number of killings.” 

The report did not mention similar trends in Asia, Africa or Oceania, due to a lack of data. 

A World Health Organization-led report last year found almost one in three women experience physical and/or sexual violence across the course of their lifetimes, and in the previous 12 months, more than one in ten women suffered from physical and/or sexual intimate partner violence.

More data key to policy formulation

UN
Women and girls in all regions are affected by gender-based killings. While Asia is
the region with the largest absolute number of killings, Africa is the region with the
highest level of violence relative to the size of its female population.

Highlighting the lack of sufficient and comprehensive data on global femicides, the new report from UN Women and UNODC said more data will enable policy makers to gain a better understanding of the issue and to push for changes. 

“Additional data beyond identification purposes, such as age of perpetrators and victims, including information surrounding the event of the killing should be collected for analytical purposes,” the report said, adding that will help policy makers detect failures in responses and protection, develop better preventive measures and improve access to justice.

Solutions include survivor-centric approaches

The report also called for more survivor-centred responses to address gender-based violence in the world, saying it’s an approach that’s “fundamental to preventing and eliminating gender-based violence against women and girls and ensuring it does not escalate to femicide/gender-related killings.”

Providing victims with a positive experience when they first report gender-based violence can increase trust and potentially save lives, and encourage other victims to report and disclose crimes.

Another measure called for in the report is stronger civil society organisations that work in the women’s rights sector, the report said, because they serve “an important role in preventing gender-based violence against women and girls, by advocating for and securing normative and policy change, providing psycho-social support services and holding governments to account.”

Image Credits: Artem Maltzev, UN Women.

Issa Abdul’s single solar panel powers his barber shop.

DAR ES SALAAM, Tanzania – Issa Abdul’s desperate urge for solar power began when he realised a smoke-spewing generator at his barber shop was costing him too much.

“Solar power is very cheap. I regret spending my money on this fuel-guzzling machine,” he told Health Policy Watch.

The 32-year-old barber in Tanzania’s port city spent roughly Tanzanian shillings 150,000 ($65) to purchase a small solar system and this now powers his hair cutting business.

“I am very happy to have my own solar system. It is very useful,” he said.

On a humid Sunday morning, Abdul adeptly digs a buzzing clipper through the hair of the client sitting on a leather chair before him.

“I was spending a lot of money every month buying fuel, that is history now,” he said.

Perched on a rusty roof, Abdul’s lone solar panel produces enough electricity to run two clippers, three bright lights and a cell phone charger.

“There’s plenty of sunshine, I don’t disappoint my customers,” he said.

Drought cripples hydropower facilities 

However, like other east African countries such as Kenya and Uganda, solar power still remains a small part of the country’s energy mix. 

While Tanzania’s electric grid has been primarily powered by hydroelectric power, another renewable source, for some time, hydro’s dominance is slipping now. 

Climate-related spells of drought have crippled the country’s hydropower facilities and the ageing distribution infrastructure, and the country is experiencing an electricity crisis affecting various sectors of the economy.

Hydropower, which can potentially generate 4.7 GW of electricity according to government estimates, is only producing 12% of its power potential, and is prone to weather variability.

And as drought tightens its grip, Tanzania, which has 57 trillion cubic feet of natural gas reserves, is now poised to tap this chunk of fossil fuels to cover the electricity deficit

Natural gas, oil and coal will almost certainly remain dominant in the country’s energy mix in the near future, according to experts.

A motorcyclist riding outside TPTL plant in Dar es Salaam that uses heavy furnace oil to produce electricity.

Addressing climate change impact with fossil fuels 

Tanzania’s experience is just one example of an emerging paradox of addressing climate change impacts with more climate-changing fossil fuel.

Tanzania, Kenya and Uganda have been dependent on hydropower, but as all three countries grapple with climate-related drought, they may also find it easier to tap their fossil fuel reserves with the help of multinational investors standing by than develop greener alternatives. This is even as technologies exist for large-scale grid-quality solar power that is ultimately cheaper, industry observers say.   

While nations worldwide are shifting to renewable energy to reduce the global carbon footprint and ease the toll that fossil fuels take on people’s health, economy and climate, the majority of Tanzanians, like those in large parts of Africa, still use dirty energy sources that pollute the air, causing some 1.1 million deaths annually on the continent, according to a recent study. 

Air pollution is the second risk factor for death in Africa after malnutrition, concluded the study by the Boston-based Health Effects Institute.   

Tanzania’s electricity generation comes mostly from natural gas (48%), followed by hydropower (31%), petrol/diesel (18%), solar (1%), and biofuels (1%). 

In Kenya and Uganda, hydropower and geothermal power are the dominant portions of the electricity generation mix, with solar power making up a very minor proportion of the mix.  

As demand for energy continues to grow, it is unclear how to ensure that renewables become more attractive than fossil fuel. Investments in fossil fuels far outweigh that of  renewables in most parts of Africa, and oil and gas exploration and exploitation continues apace in Kenya, Uganda and  Tanzania. 

Dirty diesel

At Kariakoo, a business hub in Dar es Salaam dotted with shopping centres, a toxic haze of diesel hangs in the air as generators roar so loudly that they drown out people’s conversations.

Like the lone solar panel precariously hanging on Abdul’s salon, smoke-spewing generators are widely used when grid electricity goes off. They power everything from ceiling fans to television sets, air conditioners and freezers – the latter two items pulling too much power to make a rooftop solar system reliable.

Among the available choices, portable diesel generators are among the dirtiest, spewing particulate-laden emissions into the air directly into spaces where people live and work. But they remain the go-to solution in much of Tanzania and Africa more broadly. 

“To me, a diesel generator provides the necessary power,” said Aloycia Mosha who runs a cold fish store.

Soaked with sweat, Mosha repeatedly pulls a string to rev the engine of her generator.

“If I don’t switch it on now, all my fish stock will get spoilt,” said Mosha.

The 45-year-old entrepreneur has often found a trail of blood oozing on her shop’s tiled floor, a clear sign that the fish defrosted overnight.

Vendor stand near a standby diesel generator in Dar es Salaam

Power cuts are part of daily life 

Power cuts are part of daily life in Dar es Salaam, a busy city that is home to 5.8 million people, and accounts for 40% of the country’s GDP.

While  a few city dwellers have installed solar power on their roof tops to save spiralling energy costs, analysts say the lack of clear financing mechanism to cover initial installation costs, coupled with an unreliable distribution network, have made solar systems a distant luxury to many families. 

Asteria Mchomvu, a resident of Upanga, a middle-class neighborhood in Dar es Salaam,  began to dream of installing solar panels on her roof a decade ago.

At first, Mchomvu, who works as a teacher, was excited to learn that solar technology could help her save money and protect the environment. But a home solar system was too expensive for her t the time. 

A modest 8-kilowat system would roughly cost Tanzanian shillings 10, million ($4347) in 2012, according to Tanzania’s Rural  Energy Agency.

Prices for solar systems in Tanzania have since fallen by more than 60% and companies are aggressively jostling to pitch their sales.

Yet still, the numbers didn’t work for Mchomvu, who teaches geography and science

Then early in November, at the Dar es Salaam International Trade Fair, Mchomvu caught up with Richard Tairo, a salesman from Arti energy, a solar company focusing on mid and low -income customers.

Tairo understood Mchomvu’s passion for solar and her financial dilemma and he introduced her to Mali Kauli, a program that finances residential solar systems and offers borrowers, below-market rates.

Mchomvu accepted the offer after the company assured her that the system could lower her energy bills and spare her the agony of power cuts.

“I wanted to be 100% sure it is worth investing,” she told the Health Policy Watch.

Skewed regulatory framework disadvantages solar  

Despite the growing public awareness, renewable energy penetration in Tanzania is still facing major hurdles due to a skewed regulatory framework and limited market.

Samuel Wangwe, a research associate with Research on Poverty Alleviation (REPOA) said solar power market has seen sluggish growth due to  fragmented financing plans, uneven service after equipment sale and technical weaknesses in batteries and solar lamps, which are often cheap items imported from China with warranties that cannot be honoured. 

“The most obvious barrier to renewable energy, notably solar is cost. The upfront expenses that people pay to get solar panels installed at their homes are still too high,” Wangwe said.

Many investors are discouraged to take on renewable energy projects because of high capital costs and a long net payback period, he added.

Wangwe says that the industry is also dogged by a lack of training institutes, which has prevented renewable energy technologies from scaling up.

“We must encourage our children to take renewable energy courses and hone their technical skills,” he said.

A shop for solar equipment at Kariakoo business centre in Dar es Salaam

Bigger subsidies for fossil fuels 

Although some subsidies are offered for rooftop solar, the subsidies the government provides to fossil fuel sources are much higher, Wangwe said. 

In fact, in July, the Tanzanian government introduced a new fuel subsidy of a whopping Tanzanian shillings 100 billion ($43 million) monthly to stabilise the domestic price of fuel, Wangwe said.

While solar panel and wind turbines are exempt from VAT and are not charged import duties, accessories including the batteries essential to operating a household solar package  are charged up to 35% import duty, said Wangwe.

“This is the reason why solar technology is not scaling up as fast as possible” he said.

Coal, oil and gas are by far the largest contributors to climate change, experts say.  In addition, some 65% of deaths from air pollution are generated by fossil fuel combustion, including the noisy and smokey generators that are omnipresent in households and big African cities like Dar es Salaam. 

While global leaders have endorsed the scientific consensus to limit global warming to 1.5°C above pre-industrial level, as spelled out in the Paris Agreement, there is a growing rush for oil and gas exploration in the global south.

This is what COP27 civil society participants called the “dash for gas” reminiscent of  the colonial scramble for Africa.

More fossil fuel exploration 

Tanzania has enough gas reserves to put the country on a path of economic prosperity, and may unlock as much as $30 billion in liquified natural gas (LNG) investments.

At the same time, if the historic pattern long followed in east and west Africa remains the same, many of the new LNG is likely to be sold to Europe and other countries to generate foreign currency, rather than used at home. 

“Our political leaders are caught up in a dilemma. Such investments are worthwhile economically but bad for the environment,” said Wangwe.

While many have argued that off-grid solar solutions hold the key to Tanzania’s urban and rural electrification, fossil fuels subsidies have reduced its competitiveness. 

Yusto Mugisha, professor of renewable energy at the school of engineering and technology a Sokoine University of Agriculture, said in order to build a sustainable future, Tanzania needs to invest in clean, accessible and affordable energy sources.

“Renewable energy sources are available and their potential is not fully harnessed,” said Mugisha.

Although upfront costs for renewable projects can be daunting, Mugisha said efficient and more reliable renewable technologies can create a system that is less prone to market shocks and improve energy security.

Unlike fossil fuels, which need to be extracted and transported to large power plants and require a grid network extending to remote areas, renewable sources like solar and wind can be developed in various flexible arrays. 

They can be just a few panels on a  household installation, part of a community mini-grid, or as a solar power plant feeding into the large grid. 

That, according to the International Energy Agency and countless other assessments means that solar could leap-frog over grid-dependent fossil fuel technologies much like portable phones leap-frogged over fixed phone lines in Africa, providing better service much faster.  

But renewable energy versus fossil fuels has seemingly placed Tanzania politicians in the moral dilemma. While fossil fuel provides badly needed energy, it leaves behind a carbon footprint that’s proving catastrophic to humans and the planet.

Yet, in the short term, policymakers strongly support fuel subsidies to stabilise the prices of other commodities. Meanwhile, renewable energy subsidies, notably on solar, are indirectly offered mostly through the Rural Energy Agency, and are clustered depending on the scale of the project.   

Despite its small market share local experts say renewable energy has the potential to respond to present and future challenges by enhancing energy security, generating income, and providing employment.

Rural dependence on kerosene 

William Kahise, a student at Itetemia primary school, persuaded hus mother to buy a solar lamp as the kerosene one made him cough.

In the dusty western town of Tabora, 12-year-old William Kahise and his sister Juliana routinely huddled around the faint glow of kerosene lamp when the darkness sets in, struggling to get their homework done before their mother blows off the lamp to save the fuel cost.

“I must finish my work, otherwise my teacher will be very angry,” Kahise told Health Policy Watch. 

The paraffin lamp, made from a discarded cooking oil tin, emitted choking smoke and casts scary shadows on the walls.  Kerosene is one of the household fuels that WHO has recommended not be used at all, because of its health harmful effects, including impaired lung function, asthma and cancer. 

The Itetemia primary school pupil may not know about the WHO recommendation, but he knew the smoke made him cough and convinced his mother to ditch the kerosene lantern, for a cheap solar version. 

Kerosene is used by millions of rural households i to meet basic lighting needs and subsidies have long been used to make the fuel more affordable.

Kerosene subsidies have been at the centre of energy policy debate, with renewable energy activists arguing that, for health, safety and environmental reasons, a switch to solar power is better.

“The subsidized kerosene is extremely costly and wasteful, the government is spending a lot of money every month to keep the price low,” said Mugisha.

But for Abdul, who enjoys solar power, the challenge arises when his Chinese-made panel starts to age and needs to be replaced as Africa produces virtually no panels of its own. 

–First of two parts on the barriers to clean, renewable energy in Africa.

-Research and reporting for this story was supported by the Rosa Luxembourg Foundation.

Image Credits: Peter Mgongo.

COP27
Global Young Greens protestors demanding the end of fossil fuels at COP27.

(SHARM EL-SHEIKH, Egypt via The New Humanitarian) – Climate justice played a central role at COP27, where the snail’s pace of progress on addressing the climate emergency once again stood in stark contrast to the realities on disaster front lines.

Negotiators and policymakers emerged from the annual summit in Egypt hailing a breakthrough on so-called “loss and damage” financing, agreeing to create a new fund to help countries facing the worst impacts of the crisis.

After 30 years of advocacy and pushback on the issue, arguments leaning on climate justice had a clear influence on the political agenda, with vulnerable countries and climate campaigners alike pushing similar messages.

Yeb Saño, a prominent former diplomat from the Philippines and the Southeast Asia director for Greenpeace, called it a “new dawn for climate justice”. UN Secretary-General António Guterres said it was a badly needed step “to rebuild broken trust”. Humanitarian groups branded it a “monumental win”, though the crucial details of how the fund work still need to be thrashed out in the coming months.

Yet in spite of the diplomatic negotiations and last-minute theatrics, results came up short in other key areas. “It has been a good pitch to say that it’s a COP for Africa. But the negotiations haven’t had Africa at the centre, and the needs of several millions of Africans facing starvation.”

Funds to help countries adapt to and mitigate climate change are still far short of the annual $100 billion previously pledged. Stronger wording on the phasing down of fossil fuels wasn’t included in the final negotiated text. And there were no major new promises to ratchet up emissions cuts – despite signs that country-level plans to limit temperature-rise to 1.5 degrees Celsius are significantly off target.

COP27 had been presented by its Egyptian presidency as “the implementation COP”, and as Africa’s summit, though many participants here felt that the talks disappointed on both fronts.

“It has been a good pitch to say that it’s a COP for Africa. But the negotiations haven’t had Africa at the centre, and the needs of several millions of Africans facing starvation,” Isaiah Kipyegon Toroitich, head of global advocacy at the Lutheran World Federation, told The New Humanitarian.

Frustrated by years of roadblocks by powerful countries at these summits, some civil society groups and humanitarians have concentrated their advocacy outside the negotiation rooms in an attempt to drive the needle forward. At this COP, issues like debt, gender justice, and migration emerged as hot-button concerns on the summit sidelines, if only blips on the official radar.

Here are some of the key issues that emerged – or were overlooked – during COP27, and what the next steps may include.

Loss and damage

Described as a “down payment on climate justice” by Pakistan’s climate minister, the agreement to set up a loss and damage fund must be just the start, humanitarian groups and civil society advocates say.

Farah Naureen, Pakistan director for aid group Mercy Corps, said more public funding and more innovative financing sources were needed, adding “the real work will only begin after COP27”.

While advocates view acknowledgement for loss and damage as a core part of climate justice, discussions on the new fund were only able to proceed after negotiators agreed to remove references linking funding to any form of “reparations” or “liability”, which wealthy countries worried may usher in unlimited claims.

Questions over who will pay into the fund and how the money will be distributed are still to be negotiated. European countries argued in Sharm el-Sheikh that China and oil and gas producers such as Saudi Arabia and Qatar – all considered by UN definitions as developing countries – should pay. They also want Russia to be included.

COP27
Protesters at COP27 demanding debt relief for poorer climate-vulnerable countries. (via The New Humanitarian)

A sense of who would be eligible to receive money was at least partially provided during the last sleepless night of negotiations: Negotiators agreed to a final wording that cited “developing countries that are particularly vulnerable to the adverse effects of climate change”.

“The loss and damage outcome was one that was vital for solidarity with [climate-vulnerable] countries, because it’s about the entire ecosystem that needs to happen,” Jennifer Morgan, Germany’s special climate envoy and former executive director of Greenpeace, told The New Humanitarian.

Germany and other G7 nations, along with their counterparts in the Vulnerable 20 (V20) negotiating bloc, used COP27 to announce an insurance and disaster risk finance mechanism called the Global Shield. Some critics saw it as a distraction, especially if it becomes a substitute for new funding.

But Sara Jane Ahmed, finance advisor to the V20 group, said the shield would complement a loss and damage fund. Generally, the V20 countries pushed for new loss and damage financing on top of other solutions. “We have a timing mismatch,” she said. “We need resources today; we cannot wait two to three years to get new resources to come through. We need to keep going at the same time that they find resolution working on [loss and damage].”

Adaptation finance

With much of the public focus on loss and damage, there was little progress on increasing funding for a less-controversial branch of climate finance: adaptation.

Long-standing promises of $100 billion a year have consistently been unmet. At 2021’s COP26 summit in Glasgow, countries agreed to double the funding available for adaptation – the money used to help countries prepare for and reduce the risks of climate change.

Negotiators in Sharm el-Sheikh wrangled over issues such as what baseline to use, before finally recommitting to the previous COP’s promises. They also agreed to set up a framework to track progress on adaptation.

While heads of state from traditional donor governments touted new contributions at COP27, vulnerable countries made clear it was far short of what’s needed. They have long said that adaptation funding – which could be used, for example, to make homes more storm-resistant, to restore coastlines, and to build flood defences – should be more balanced with financing available for mitigation or reducing emissions, which traditionally sees the bulk of the climate funding.

For aid agencies and NGOs, which maintained a strong presence at COP27, insufficient adaptation means climate impacts have become even more challenging to respond to.

Andrew Harper, chief climate advisor at the UN’s refugee agency, UNHCR, said high-profile crises such as the conflict in Ukraine have left less money for “forgotten” emergencies worsened by climate change.

With only 4% of climate finance directed to Africa, mostly in the form of loans instead of grants, and most of it going to mitigation, Harper said: “it is clear that the developing countries who have been doing the most to protect and support refugees, sometimes for decades, demonstrating a level of global solidarity that many in the [Global] North could learn from, are not benefitting at all from even the miniscule funding that is available.”

Reforming the global financial system

Some of the most far-reaching reform proposals weren’t found on the COP27 agenda, but became talking points throughout the summit.

Trapped in a cycle of climate-linked disasters and crushing rebuilding debt, countries like Barbados have led the push to reform the global financial system. Prime Minister Mia Mottley, has called for a range of reforms including loan conditions that would suspend payments after they are hit by disasters or pandemics. Her Bridgetown Agenda suggests that substantial funds could be unlocked through debt relief, more accessible loans, and other reform measures – allowing countries to spend on recovery and reconstruction instead of paying down debt.

Mottley and others used the COP27 stage to call for an overhaul of the global financial system that has trapped climate-vulnerable countries in a cycle of debt. She argues that the Bretton Woods institutions set up following World War II, including the International Monetary Fund and the World Bank, are not serving countries that regularly face increasingly intense and unpredictable disasters.

While loss and damage remains divisive despite progress in Egypt, there’s much greater appetite for financial reforms. Humanitarian groups and the UN’s Guterres are also pushing for debt relief. The US has echoed calls to reform multilateral lending. Even David Malpass, the head of the World Bank, has cited the need to “make progress in the debt agenda”.

Migration

Human mobility was not on the official COP agenda, but displacement – particularly from conflicts worsened by climate change – was a key concern in sideline discussions, especially those attended by the humanitarian aid sector.

Floods and storms, which are aggravated by climate change, pushed at least 21.6 million people from their homes last year, and climate change can also intensify other causes of displacement.

Some believe mobility should be viewed as a way that people adapt to climate change, and say financial support for programmes that assist displaced people should be a part of much-needed adaptation finances in the future.

The final COP27 text cited “displacement”, “relocation”, and “migration” as some of the many “gaps” that need to be tackled in the coming months as the new loss and damage financing is discussed – potentially carving out more space for mobility in coming climate negotiations.

And refugees and displaced people themselves need seats at the COP28 table in Dubai, UNHCR said.

Gender justice

Gender justice has for years been sidelined as a “fringe” issue at climate talks. But women activists have pushed for greater representation at the negotiating table, unique financing, and attention to the climate costs faced by women and girls.

Little of substance on gender issues was mentioned in the final COP27 text, leaving observers disappointed.

“Gender was only marginally mentioned, if at all, in the climate talks’ decisions,” Oxfam said.

Reem Alsalem, the UN special rapporteur on violence, has said that climate change represented the “most consequential threat multiplier for women and girls” and increased the risk and prevalence of violence against them.

Beverly Musili, a gender justice activist and lawyer with the Kenya Institute for Public Policy Research and Analysis, or KIPPRA, said gender still remained very much on the backburner during COP27.  “Gender was only marginally mentioned, if at all, in the climate talks’ decisions.” 

She noted that in pastoralist societies in Kenya – where gender inequalities are present – drought is exacerbating impacts on women and girls. “Due to climate change, poverty has been growing and child marriage will most likely regress,” she said.

Her organisation has been trying to educate families about the importance of girls attending school, but “with climate change come more fundamental questions of, ‘Are we going to send our children to school or are we going to look for food?’”

Indigenous women and rural women play key roles in ensuring food security for their communities, as well as in climate change adaptation efforts. In many communities, however, women are marginalised, putting them at greater risk, particularly in the face of climate change.

In spite of the distance and logistical difficulties of travelling to Egypt, Indigenous women from the Amazon were prominent at COP27. They have been leading the drive to recognise the role their communities play in protecting forests; the final text from COP recognised nature-based solutions, a mechanism that can be used to cut carbon emissions, an implicit acknowledgement of the importance of preserving natural ecosystems.

There’s still a clear gender imbalance when it comes to the COP negotiating table, as underlined by the “family shot” of heads of state taken at the summit’s opening: Only 7 of the 110 pictured were women.

In an effort to change the balance, one group, She Changes Climate, encouraged the United Arab Emirates, which will host next year’s climate talks, to appoint a woman as COP28 president: the current minister of climate change and the environment, Mariam Almheiri.

Global climate action beyond COP27

Facing slow progress at the annual UN-led climate summits, countries are finding other ways to accelerate climate action.

The campaign for debt relief and systemic financial reform is one example. The push to bring climate change and human rights to the International Court of Justice is another.

Backed by a catchy music video, the Pacific island nation of Vanuatu used COP27 to announce that its allies have almost finalised a resolution that could put the issue before the UN General Assembly and – if passed there – the UN’s top court.

Years of inaction at COP summits contributed to initial plans for legal action.

“What we have seen this week is that negotiations are not working for the most vulnerable,” said Ralph Regenvanu, Vanuatu’s minister for climate change.

Image Credits: Twitter/Global Young Greens, Paula Dupraz-Dobias/TNH.

Civil society in Geneva call for an IP waiver for COVID vaccines with UNAIDS Executive Director Winnie Byanyima earlier in the year.

Little agreement emerged from an informal World Trade Organization (WTO) meeting on Tuesday about whether an intellectual property (IP) waiver should be extended to COVID-19 therapeutics and diagnostics.

But low and middle-income countries (LMIC) that qualify for free COVID-19 anti-virals Paxlovid (nirmatrelvir) and Molnupiravir have shown so little interest in accepting donations that some question whether debating the waiver extension is a waste of time.

Singapore, Switzerland, Japan, Korea, the European Union and the United Kingdom wanted to see proof of IP barriers hampering access to therapeutics and diagnostics before they supported any waiver extension, according to a Geneva-based trade official at the WTO meeting.

Meanwhile, Switzerland and Mexico argued that the ship has already sailed as there is little demand for therapeutics.

The WTO’s TRIPS Council has until 17 December to decide on whether to extend June’s Ministerial Decision on a patent waiver on COVID-19 vaccines. 

But at Tuesday’s meeting, there was no new movement towards consensus, according to the trade official.

Parties still pushing for the waiver include South Africa, India, Sri Lanka, Nepal, Nigeria and Indonesia – all part of the core group that first introduced the notion of a TRIPS waiver for all COVID-related products.

Meanwhile, China and Mexico are part of a group that supports a limited waiver on specified products.

Lack of access – or lack of interest?

Shortly before the WTO meeting, Oxfam and the People’s Vaccine Alliance (PVA) decried the fact that rich countries have secured almost three times as many courses of a World Health Organisation (WHO)-recommended COVID-19 medicine, Pfizer’s Paxlovid.

“Just a quarter of orders for the treatment will go to low- and middle-income countries (LMICs), despite the fact they make up 84% of the world’s population and have a much greater need as far fewer people are vaccinated against COVID, unlike rich nations which are largely protected,” said the two bodies in a media statement this week, warning of “the same worrying trend of inequity that we saw with COVID vaccines”. 

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) disputed this, saying that “of the 105 lower-income countries eligible for COVID-19 treatments coordinated by the ACT Accelerator, very few countries have expressed an interest and barely a handful have so far placed very low volume orders.”

“The lack of demand means that, of the 38 generic companies lined up to produce Paxlovid and the 27 companies with licenses for Molnupiravir, there is currently barely a market for even a handful of companies to operate,” the IFPMA told Health Policy Watch.

The Oxfam-PVA figures were drawn from Airfinity, an independent provider of global health analytics and data.

Airfinity’s CEO, Rasmus Hansen, told Health Policy Watch that it was correct that only around 25% of purchased doses of Paxlovid were going to LMIC.

“But it’s a bit of a mistake only to look at that number without looking at some other demand indicators,” Hansen added.

One important indicator was the demand for Paxlovid doses from countries that qualified for the medication for free through the ACT Accelerator, he added.

“Only around 7% of the Paxlovid doses that are available for donation have been accepted by low-income countries. When I saw that number, I was really surprised you because that’s not a pricing issue,” said Hansen.

Meanwhile, the total demand from LMICs for both WHO-approved antivirals – Molnupiravir and Paxlovid – available free via the ACT-Accelerator had only reached 13%, and there had been zero demand for either medication in the fourth quarter of the year, said Hansen.

‘This available number of doses is not even the full 25% of doses available for donation. I think this is about 10% of the donations promised,” he added.

More complicated than availability

“The story is more complicated than doses not being available. There seems to be an issue with a country’s ability or willingness to use the medicine.”

Hansen speculated that factors influencing this could include countries’ inability to conduct systematic COVID-19 testing as antivirals have to be given early to prevent serious illness, as well as them having other health priorities.

He also said that a country might not accept a donated drug not because they didn’t need it but because they lacked the capacity to roll it out.

Hansen also said that the lack of data about hospitalizations, particularly in Africa, meant that deciding on what was needed “is a little bit like shooting in the dark because we don’t actually have factual data on how many are severely ill by COVID”. 

Image Credits: @FilesGeneva , Airfinity.

Bacteria
Bacterial infections are the secong leading cause of deaths in 2019.

Some 7.7 million people are estimated to have been killed by bacterial pathogens in 2019 according to a study published in The Lancet this week, making this the second leading cause of death globally in2019. 

Some 33 bacterial pathogens across 11 infectious syndromes were linked to 13.6% of all global deaths in 2019, according to the study, which was led by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington

Almost 55% of these bacterial deaths came from just five pathogens – Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. 

The worst impact of these bacteria is in sub-Saharan Africa, where the mortality rate is 230 deaths per 100,000 population in comparison to 52 deaths per 100,000 in high-income countries. 

“Effective antimicrobials exist for all 33 of the investigated bacteria, yet much of the disproportionately high burden in LMICs might be attributable to inadequate access to effective antimicrobials, weak health systems, and insufficient prevention programmes,” the study added. 

In January, the IHME reported on deaths associated with 23 pathogens and pegged the number of deaths due to antimicrobial-resistant pathogens at 4.95 million. However, the current study analyses deaths caused by bacteria that are both susceptible and resistant to antimicrobials. 

More R&D funding 

Bacterial pathogens such as E coli and K pneumoniae are collectively associated with more deaths than S pneumoniae or tuberculosis, but they receive much less funding and attention than other diseases. 

“A 2020 analysis of global funding for infectious disease research found that HIV research was awarded $42 billion in funding compared with $1.4 billion for research on Staphylococcus spp and $800 million for E coli research over the same period (between 2000 and 2017),” the paper stated. 

IHME director Chris Murray urged those who invest in research and development to take a “pathogen view” when making decisions, adding that governmental research authorities and private players like pharmaceutical companies need to keep this in mind when developing new antibiotics and vaccines. 

“It also helps get a sense in different parts of the world. We put a lot of emphases, appropriately so, on HIV, TB, and malaria but we probably need to pay as much attention to something that’s quite neglected, like Staph aureus, that’s affecting poor countries as well as rich countries.”

Need for coordinated action

Targeted efforts must be made to improve access to healthcare and antibiotics in order to reduce mortality due to bacterial pathogens, according to the report. 

However, it warned that while addressing access issues, it is crucial to also assess the risk of misuse of antibiotics. 

“Improving access to antibiotics requires a nuanced and location-specific response because ease of access must be weighed against the risk of antibiotic overuse (a problem compounded by the issue of self-medication in LMICs), which contributes to the increase in antimicrobial resistance.”

The study also advocates for higher uptake of vaccines that target the most common pathogens and vaccine development for bacteria for which no vaccine exists.

In July, the WHO released a report on the antibacterial vaccines in the pipeline, calling for higher investment into vaccine candidates that can tackle drug-resistant bacteria. 

Vaccines exist to tackle four of the priority pathogens identified by WHO, but there are no vaccine candidates in the pipeline against six of the priority pathogens in WHO’s list including those that cause common infections like urinary tract infections and gastro-intestinal illnesses.  

Image Credits: Photo by CDC on Unsplash, Photo by Myriam Zilles on Unsplash.

Should the World Health Organization (WHO) intervene on social networks and other organic platforms that are providing health information? And, if so, how?

These were pressing questions raised on Tuesday during a webinar presented by the Global Health Centre at the Graduate Institute Geneva in coordination with the Digital Health and Rights Project. 

Project researchers and participants presented their findings from a transnational participatory action research study into young adults’ experiences with digital health in Bangladesh, Colombia, Ghana, Kenya and Vietnam, raising important questions around the role that the organized health community can play in regulating organic digital health content. 

They also offered policy recommendations and good practices to help challenge structural inequalities and meet the needs of young people in their diversity based on the results of their work. 

Tabitha Ha, an advocacy manager for STOPAIDS, called on WHO to update its definition of digital health to include Google and social networks as digital health platforms, which could then enable the organization to evaluate the health content on these platforms and support local health agencies doing the same.

But Ha cautioned that while there is a need for collective approaches to managing health data on the world wide web: “If an institution like WHO was to come in, how would that change the dynamics? It could potentially influence the way people use social media to create this type of [health] content.”

Maintaining basic standards

Ha and colleague, Stephen Agbenyo, executive director of Savana Signatures, recommended that WHO works from a distance, perhaps providing supervisory support and ensuring that certain basic standards are maintained, while not interfering directly with the content creators on the ground.

WHO could, for example, communicate with large tech companies about the need for relevant sexual health information to get out to youth, including more explicit information that may, at first glance, appear to violate community standards on some social platforms.

Terry Gachie, country coordinator for Love Matters Kenya, said that her team faces consistent censorship by the social networks – especially Facebook – for posting content that could appear to violate community standards when, in fact, this is the edgy information her constituents need to learn about sexual and reproductive health. 

“We want to speak their language. But what happens in most cases is that our information is flagged, perhaps labeled as escort services or inappropriate, and then taken down,” Gachie explained. She called on WHO to bring social networks into the conversation to help find a solution. 

“We need to ensure there are consistent conversations with big tech companies in terms of what young people want to see,” Gachie said. 

Finally, the issue of regulation was raised, less as a means to control the flow of information on social networks than to ensure that people accessing the information on these networks can feel safe. 

“How do we facilitate the relationship between disseminating accurate information to people who might be at risk, who might be marginalized, and who want to hop onto this platform to access that content?” Nomtika Mjwana, project manager for the Global Network of People Living with HIV, asked. 

Nomtika Mjwana

She recommended leveraging the direct involvement of young people and the communities who use these platforms to come up with data protection mechanisms so that people can trust the platforms they are on. 

This could mean finding ways to halt data security breaches before they happen, to ensuring that when a young person enters a chat room he or she will not be met with an imposter nor need to fear that the digital voice on the other end will engage in discriminatory or insulting behavior. 

These regulations could also include rules around the use of data, so that if a person is being asked to provide information about his or her sexual orientation or identity, there is an understanding of to whom that information is going and how it will be used. 

“It’s really critiquing the way we’re collecting certain types of data and how that data is going to continue to empower the people we are getting the data from, but also just doing a thorough scan, and understanding from people that we’ve defined as prospective users of the platform or people that will access the information, what are some of their fears, and how can we very actively and proactively ensure that some of those are at least incubated in the initial stages,” Mjwana said. 

Digital transformation 

The Digital Health and Rights Project, overseen by the Graduate Institute’s Sara Davis, came about as a result of the transformation of the world’s health systems by technology. 

“The global context for our study is really this very rapid rise of the digital transformation and digital health, which was of course accelerated by the COVID pandemic,” Davis said in her opening remarks on Tuesday. “Global health and national health agencies are really embracing this trend. In 2021, the World Health Organization launched a global strategy for digital health, which called on countries to strengthen health systems with digital technologies and data.”

She highlighted how global agencies are forming partnerships with big tech companies while, at the same time, there have been a lot of concerns raised by United Nations human rights experts and scholars about threats to privacy, non-discrimination and the threat of potential privatization of public services. 

Digital Health and Rights

“In addition, because we’re working closely with people living with HIV and vulnerable to HIV, we have over three decades of evidence showing the impact of stigma, discrimination, criminalization and gender inequality on health responses, and also the impact of these things on data, access to technologies and access to power in different forums,” Davis added. “We really wondered … how these inequalities would play out in the digital transformation.”

The project research was conducted in five countries and has so far included 174 young adults between the ages of 18 and 30, in addition to 83 key informant interviews. The report released Tuesday centered on efforts in Ghana, Kenya and Vietnam, and teased the results coming out of Bangladesh and Colombia, where the team just finished the fieldwork.

Empowering access

“One of our first key findings has been specifically based on the fact that young people actually appreciate having access to digital health technologies,” Mjwana explained. “They’ve described it as empowering.”

Google came up in a number of focus group discussions and some key informant interviews, along with social media and WhatsApp, as one of the most important ways in which people find information, a community, and safe spaces to engage and address some of the concerns that they had but did not want to address by going to health facilities where they might feel judged. 

“The online space has actually afforded some people a platform to not necessarily feel that they have to out themselves,” Mjwana said.

A second finding centered around the fact that a lot of inequalities seen offline continue to play a role in the online space, such as gender, socioeconomic status, education, language, disability, sexual orientation or even location. This could mean individuals not having the funds to purchase needed technologies, or experiencing censorship, violence or harm in the online sphere. 

“We’ve come to realize how the digital divide is actually intersectional,” Mjwana said.

Issues of surveillance and regulation also came out as concerns in the study. 

When people were asked where they think their data is going, many did not know and felt this was a concern that they had to deal with on their own. Some young people assumed their data was going to a third party, while others imagined the data was going to the platform itself or even the police. 

Digital health literacy and empowerment was also emphasized, as well as having a voice in policy making and calling on health officials to bring young people into conversations as champions on social media. 

Dr Mike Ryan, one of the senior WHO officials who has survived the cut, with Dr Tedros, and Maria Van Kerkhove.

Half of the World Health Organization’s (WHO) 16-member senior leadership team at the Geneva headquarters will leave the global body at the end of November, including Chief Scientist Dr Soumya Swaminathan and Dr Mariângela Simão, Assistant Director-General for access to medicines and health products.

The announcement of the departure of the eight senior leaders was made in a short email to staff by Director-General Dr Tedros Adhanom Ghebreyusus on Tuesday, thanking the leaders for their service.

Despite the low-key internal announcement, this is the biggest single leadership change that Tedros has made since 2019, two years after he took office, when he made a set of sweeping changes as part of his “Transformation” agenda for the organization. It has been anticipated for months by Geneva insiders who say the Director-General has been itching to shake up his team since being re-elected for a second term. Additionally, there have been pressures from large donors for Tedros to streamline his senior team, which was unprecedentedly large, and some said, top-heavy.  

Although Tedros said that the officials were all leaving because their appointments are coming to an end, he has obviously chosen not to renew the appointments of a number of those who are not at retirement age and were available.

Tedros said that the departing staff members had “contributed to a significant and enduring transformation of the organisation and helped steer WHO through a global pandemic that ravaged the health and well-being of the entire world and had a profound and ongoing impact on global public health”.

Thanking them, he added that they have made “a truly positive difference, and their legacy is a strengthened and more agile, equitable, and resilient WHO”.

Health Policy Watch was the first to report on Swaminathan’s departure in early October, reporting that the Indian paediatrician’s leadership style may have been too independent for Tedros.

Medicine access stalwarts

Dr Mariângela Simão, WHO Assistant to the Director General.

Swaminathan and Simão, who came to the WHO via UNIAIDS, have consistently  championed access to COVID-19 vaccines for low and middle-income countries, often criticising wealthy countries and pharmaceutical companies for obstructing this.

Simão has spent much of her career working to expand access to medicine, particularly for those living with HIV, and she served as Director of STDs, AIDS and Hepatitis Department in Brazil’s Health Ministry between 2006 and 2010, where she led successful price negotiations with pharmaceutical companies to lower the price of HIV medication

Dr Agnès Buzyn, the WHO Director-General’s Envoy for Multilateral Affairs, was recently appointed executive director of the WHO Academy in Lyon, and the former French health minister remains on the leadership team in her new role. Former French Global Health Ambassador Stéphanie Seydoux has already been announced as her successor.

Who’s out – and who’s still in?

On his way out: Dr Jaouad Mahjour

Jane Ellison, executive director for external relations and governance and former UK health minister, is also leaving, as is Dr Jaouard Mahjour, Assistant Director-General for emergency preparedness and international health regulations. Mahjour held various positions in the WHO’s Eastern Mediterranean Regional Office.

As previously reported, Dr Ren Minghui, Assistant Director-General for universal health coverage (UHC), and communicable and non-communicable diseases, also joins the exodus. Chinese national Minghui was previously director-general for international cooperation at the National Health and Family Planning Commission of China.

South African Dr Princess Nothemba Simelela, Assistant Director-General and special adviser on strategic priorities, who has been working on cervical cancer, is also departing. Simelela previously headed South Africa’s HIV programme. 

Key managerial appointments to the major WHO work clusters made in 2019, not including DGO advisors, most of which have left or will now be departing.

Finally,  Japanese national Dr Naoko Yamamoto, Assistant Director-General for UHC and healthier populations, will also be departing. 

The departure of WHO Deputy Director Dr Zsuzsanna Jakab, the 71-year-old Hungarian who is well over the WHO mandatory retirement age of 65, is also expected to be imminent. 

Also leaving are the WHO’s chief nursing officer, Dr Elizabeth Iro and Min-Whee Kang, senior adviser in the Director-General’s Office, neither of whom are part of the senior leadership team, as such.

Surviving the cut are Dr Mike Ryan, Dr Samira Asma, Prof Hanan Balkhy, Dr Ibrahima Socé Fall, Raul Thomas and special advisers Bruce Aylward and Peter Singer, alongside Dr Chikwe Ihekweazu, who was recently appointed as head of the WHO Hub for Pandemic and Epidemic Intelligence, and Stewart Simonson, who heads the WHO’s US office. 

Other than Seydoux, no replacements have been named. However, in light of the pressure Tedros has been under from member states, particularly the US, to cut costs, it is possible that he may also cut the size of his team.  WHO staff had also complained about the swollen management team, including the pattern of appointing senior advisors housed in the DGO’s office, who were not responsible for any particular WHO cluster, and enjoy exceedingly high salaries.  

Image Credits: Twitter: @WHO, WHO.

Oral Health

Oral diseases are the most common form of noncommunicable disease (NCD) in the world. Globally, these conditions affect almost 3.5 billion people – almost half of the world’s population.

Long a neglected subject in global health circles, oral diseases affect about 1 billion more people than all five main NCDs – mental disorders, cardiovascular disease, diabetes, chronic respiratory diseases and cancers – combined, and global case numbers have increased by 1 billion over the last 30 years. Today, the WHO team responsible for its oral health agenda is still made up of just 3 people.

“It’s a huge burden,” Dr Benoit Varenne, WHO team lead for oral health strategy told Health Policy Watch. “And that burden is increasing, especially in low- and middle-income countries.”

And the world has begun to take notice. The WHO’s Global Oral Health Status Report published Friday reflects a new focus on the importance of oral diseases. Encompassing data from 194 countries, the report is the first comprehensive overview of oral disease burden worldwide.

It follows the direction set out by the World Health Assembly’s adoption of a watershed resolution on oral health in 2021, which agreed the objective of universal health coverage for oral health services by 2030.

“The adoption by WHO Member States of a historic resolution on oral health at the World Health Assembly in 2021 was an important step forward,” said WHO Director-General Dr Tedros Ghebreyesus. “WHO is committed to providing guidance and support to countries so that all people, wherever they live and whatever their income, have the knowledge and tools needed.”

First comprehensive global report spotlights glaring inequalities

Workforce availability is at the heart of failures to address the oral health threat.

Three out of every four people affected by oral health conditions live in low- and middle-income countries. Oral diseases are part of the NCD family, but have yet to be well integrated into the global NCD agenda. 

“All oral diseases show strong social gradients, disproportionately affecting the most vulnerable and disadvantaged population groups,” the report found. “People on low incomes, people living with disabilities, people who are refugees, older people living alone or in care homes, in prison or living in remote and rural communities, children and people from minority and other socially marginalized groups generally carry a higher burden.”

The patterns of inequality present in the distribution of oral disease burden globally are comparable to those seen with cancers, cardiovascular diseases, or diabetes. Oral health also shared the common risk factors of all forms of tobacco and alcohol use, as well as high sugar intake. 

“One of the key messages of this report is that we are part of NCD family because we are share the common risk factors with other major NCDs,” Varenne said.  “We have to invest on this upstream population based strategy in collaboration with other programs and in countries.”

Inequalities also exist at the sub-national level. Public and private services tend to be over-concentrated in wealthy urban areas due to the need for expensive technology to administer care, often leaving rural regions with no access to even the most basic oral health services.

Back to basics: essential care too often overlooked by oral health systems

Essential and preventative care is often overlooked by the predominant model of oral health systems. Training other medical staff to be able to administer basic oral care would be hugely beneficial to populations outside urban centers.

Oral diseases are largely preventable. On paper, the ideal oral health system should focus on the delivery of preventative care, and support patients with education in self-care practices to promote independence. Essential care is the most critical, but the current model being practiced around the work focuses on the complex.

“Most of the countries built their oral care system on the dental care models from high income countries that are based on high-technologies and specialized providers.” said Dr Benoit Varenne, leader of WHO’s oral health team. “And the workforce is more or less all concentrated in urban areas.”

Emulation of the high-income country model frequently results in “system-level failures in the model of care and provision of oral health services” which largely rely on expensive high-tech equipment and materials, highly specialized providers and too few midlevel providers,” the report notes.  

The reliance on a model contingent on a highly specialized workforce – with many roles requiring up to 7 years of education – does a disservice to the provision of simple, non-invasive pain relief of prevention treatments to populations lacking access to sophisticated oral care facilities. 

The report emphasizes the benefits of training other health professionals in the provision of essential oral health services to increase access in non-urban areas, and alleviate the stark inequality in the distribution of the highly-specialized workforce. 

At the time of writing, Sub-Saharan Africa and parts of Southeast Asia reported the lowest absolute numbers of professional-to-population ratios for oral health care in the world. 

“We hope the approaches outlined in the report will improve the situation and reduce inequalities,” Varenne said.

Ukraine
Russian airstrike hits Mariupol maternity hospital, 9 March 2022.

As the first snows fall across Ukraine, World Health Organization officials in Kyiv warn the coming winter will be “life-threatening for millions” of Ukrainians.

At a press conference in Kyiv on Monday, WHO’s European Regional Director Dr Hans Kluge called the Russian airstrikes on Ukraine’s energy and medical infrastructure “the largest attack on health care on European soil since the Second World War.”

“This winter will be about survival,” Kluge said. “Today 10 million people – a quarter of the population – are without power, and cold weather can kill.”

Russian forces have conducted 703 attacks on Ukrainian healthcare infrastructure since the start of their invasion in February. As of 16 November, 144 medical facilities have been reduced to rubble, according to Ukraine’s Ministry of Health. 

“This is a clear breach of international humanitarian law and the rules of war,” Kluge told reporters. “This war must end before the health system and the health of the Ukrainian nation are compromised any further. Access to healthcare cannot be held hostage.”

Kluge called on Russian forces to immediately open humanitarian corridors to the remaining occupied regions. Russia has so far blocked efforts by international organisations to deliver aid to the territories it controls, leaving many Ukranians cut off from the more than 9 thousand tons of medical supplies delivered by 35 countries from around the world since February. 

“This is an unacceptable situation,” Kluge said. “What’s happening in Mariupol, what’s happening in Donbas. We know there are 17,000 people with HIV in Donetsk alone who may soon run out of the critical antiretroviral drugs that help keep them alive.”  Donetsk is one of two major subregions in the historical Donbas in the eastern part of Ukraine, the other being Luhansk, where large parts of territory remain under Russian military control. 

In his appeal to the international community for further financial support for the Ukrainian health sector, Kluge outlined the actions being taken by the WHO and international partners to help Ukraine’s health system prepare for the coming winter months. 

These include repairs to health facilities, heating infrastructure and energy lifelines, and the provision of portable heating devices, medical supplies, diesel generators, and ambulances. 

“Ukraine’s medical system saves the lives of our citizens every minute – sometimes it takes minutes, so increasing the number of such machines increases the chances of providing timely and high-quality care and saving the lives of patients,” Ukrainian Minister of Health Viktor Lyashko said of the delivery of two ambulances to the Sumy region this week. 

The Government of Ukraine, WHO and key international organisations will hold a series of high level meetings to discuss support for Ukraine’s health care system over the coming days. 

“No primary health care centers” in war-torn east

WHO
WHO Europe Regional Director Hans Kluge and WHO Ukraine representative Jarno Habicht preparing to speak at a press conference in Kyiv on Monday. Journalists were warned of the possibility the session could be postponed if air raid sirens forced attendees to relocate to safety.

The most urgent mission facing the WHO and its international partners is getting aid to newly liberated territories like Kherson and Mykolaiv. Russian troops fleeing the cities left health, energy, water and sanitation infrastructure in total disrepair, spurring Ukrainian authorities to begin voluntary evacuations in the region amid fears of a humanitarian crisis brought on by arrival of the harsh Ukrainian winter. 

“In the newly liberated territories there is the big challenge non-communicable diseases, chronic diseases – diabetes, hypertension, chronic respiratory infections – because there is quite an elderly population,” said Kluge.

In Kherson, people did not have hot water or electricity for over two weeks leading up to its liberation by Ukrainian troops recently following a Russian withdrawl from the city. The Russian blockade of medical and humanitarian supplies has left food stocks running low, pharmacy shelves empty, and medical facilities without medicine. 

“In the liberated areas, there are no pharmacies,” Kluge said of his contacts with authorities and volunteer organizations on the ground. “There are not any primary health care centers functioning.”

Rolling blackouts hit homes and hospitals as winter approaches 

Kyiv
Temperatures in the Ukrainian winter can drop as low as -20°C.

Meanwhile, rolling blackouts caused by the continued Russian assault on Ukraine’s energy grid are threatening the ability of medical facilities to continue operating, and depriving civilians of heat for their homes, access primary and urgent care, clean water, and essential humanitarian services.

“Without electricity the machines in intensive care units stop working, surgeries cannot continue, and cold chain facilities needed for vaccines and medicines will be disrupted” said WHO Ukraine Representative Dr Jarno Habicht. “One can only imagine the impact on civilians across Ukraine.”

The latest WHO estimates put the average number of patients treated in the healthcare facilities forced offline by attacks across Ukraine at 421 thousand patients per month. Already short on capacity, the threat of the remaining maternity wards, blood banks, and intensive care beds not having access to the electricity needed to run incubators, refrigeration units and ventilators to Ukraine’s health systems is generating fears of a deadly winter.  

“We usually celebrate the snow,” Habicht said. “But this winter will be different.”

Almost one in five Ukrainians are unable to obtain the medicine they need. In the east, this number increases to one in three, the WHO said. Across the country, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimates 9.3 million people require food and basic livelihood assistance, and 14.5 million are in need of health assistance.

COVID-19 threat heightened by arrival of winter

As of January, only one out of three Ukrainians remain vaccinated against COVID-19. It is during the winter season that respiratory infections are at their most dangerous, and coupled with the threats of pneumonia, influenza and a health care system under strain from the war effort, low-vaccination coverage poses a heightened risk. 

“Millions of Ukrainians have waning or no immunity to COVID-19,” said Kluge. “Couple that with an expected surge in seasonal influenza and difficulties in accessing health services, and this could spell disaster for vulnerable people.”

“Ukraine’s health system is facing its darkest days in the war so far,” he warned. “It is being squeezed from all sides, and the ultimate casualty is a patient.”

Elderly population at acute risk

Ivlev-Yorke
Many elderly people are not physically fit enough to evacuate by train on their own. Others are reluctant to leave their lives and homes behind.

At the onset of the war, hospitals and health facilities were asked to stop all non-emergency care in preparation for the burden of the wounded. This makes the elderly – especially those dependent on regular care for chronic diseases – acutely vulnerable. About 20% of the Ukrainian population is above the age of 60.

The reorientation of Ukraine’s medical system to wartime footing has left few staff available to provide primary healthcare for older people suffering from non-communicable diseases, and severely disrupted the availability of life-saving medications like insulin – especially in frontline regions.

“Access to healthcare, including primary care, has become extremely difficult,” Médecins Sans Frontières testified of their experience in Ukraine. “In combination with an already damaged and disrupted healthcare system, this creates serious issues for continuity of care [for patients suffering from chronic illnesses].” 

The social services relied on by many older Ukrainians have also been heavily impacted by the war, leaving many with no recourse to treatment.

The limited mobility of many elderly people also makes evacuation a more difficult task than for the young and healthy. Some choose to stay, unable to envision leaving the lives and cities they call home behind. 

Children caught in the cross-fire

A mother and her two children are evacuated from the frontlines of the Donbas region by an international team of volunteers.

War is particularly unkind to vulnerable populations, and the situation in Ukraine is no exception: children are caught in the cross-fire.

Today, some 3.4 million Ukrainian children need “child-protection interventions,” according to OCHA. These include services such as family tracing and reunification, psychological support and alternative care arrangements. 

As of 10 November, OCHA said 1.67 million children, parents and caregivers have received child-protection related support, with 650,000 children having received psycho-social support to cope with the traumatic effects of war and displacement. 550,000 caregivers – 71% of whom are women – who were provided sessions on supporting their children through the mental challenges of the war.

Caught between the mental weight of war and freezing temperatures, even warmth – absent access to clean electricity – poses its own set of dangers. 

“As desperate families try to stay warm, many will be forced to turn to alternative heating methods like burning charcoal, wood, or using generators fueled by diesel or electric heaters,” Kluge said. “These bring health risks, including exposure to toxic substances that are harmful for children.”

Many children have also been separated from their families as part of the thousands of Ukrainians forcibly deported to Russia and occupied territories since the start of the invasion. Exact numbers remain elusive, but the Ukrainian government has so far identified over 10,000 children matching this description.

Médecins Sans Frontières has reported treating patients as young as six-weeks old, and recent estimates count 437 children among the more than 8,300 civilians killed since February. The UN High Commissioner for Human Rights has confirmed an additional 505 children injured among the 10,000 injured civilians.

With no visibility on the situation in Russian occupied areas like Mariupol and casualty verification processes ongoing, the number is likely far higher.

October alone saw over 450,000 people flee to safety across Ukraine. Of these, 280,000 were people leaving the east of the country, according to the latest data from the International Organisation for Migration (IOM).

A total of 14.3 million Ukrainians have already been forcibly displaced by the conflict. As the harsh Ukrainian winter settles in, the WHO projects an additional 3 million will be forced to flee in search of warmth and safety over the winter.

Image Credits: Мstyslav Chernov, WHO, Mariusz Kluzniak, Ignatius Ivlev-Yorke, Ignatius Ivlev-Yorke.