An examination of 51 studies has assembled more evidence that exposure to air pollution is linked to a higher risk of dementia.

Air pollution, specifically the tiny particles known as PM2.5, is linked to higher rates of dementia, according to a recently published study in The Lancet.

Nitrogen dioxide (NO2) and black carbon, which is the black soot left behind when combustion is incomplete, have also been linked to higher risk of dementia in the study, which is headed by researchers at UK’s Cambridge University.

“What this means is that cleaner air policies, including those targeting diesel, could help protect brain health, not just lung and heart health. Dementia is a devastating disease, and while we wait for a cure, we need to act on modifiable risk factors. Air pollution is one of the biggest,” Haneen Khreis, one of the authors of the study, told Health Policy Watch.

Researchers reviewed 51 existing studies across several countries up to October 2023 to arrive at this conclusion.

PM2.5 is 1/28 of the width of a human air and much of it is released during the burning of gasoline, oil, diesel or wood. PM10 particles are relatively larger, though still invisible to the naked eye.

“PM2.5, or fine particulate matter, can cross the blood-brain barrier, resulting in inflammation and disruption of brain function. There is also evidence to suggest that fine particles can travel through the olfactory nerve into the brain,” Pallavi Pant, who is the head of global initiatives at Health Effects Institute told HPW.

“Exposure to air pollution may also have impacts on brain development and functioning in children, including an increased risk for neurodevelopmental disorders like autism and psychological disorders like anxiety and depression,” Pant pointed out.

The dangers of PM2.5

A comparison of the sizes of PM2.5, PM10, human hair and fine beach sand.

Air pollutants are categorized by their sizes. There is PM2.5 and there is PM10. Evidence does not yet link PM10 with higher rates of dementia, but the number of studies looking closely at PM10 were small, the researchers concluded.

Gases like NO2, and particles the size of PM2.5 or less, are dangerous because they are small enough to enter the bloodstream from the lungs after being inhaled.

Once inside the body, they can travel from head to toe, according to Palak Balyan, research lead at Climate Trends, headquartered in New Delhi.

There are two ways patients can develop dementia, a broad term describing a decline in mental abilities severe enough to interfere with a person’s everyday life, says Balyan.

One is a natural consequence of ageing, while the other is caused by blockage in the brain – including by air pollution.

“These small particles (PM2.5) block a lot of arteries, veins or small capillaries in our brain. That also leads to dementia,” she said.

Black carbon

While PM2.5 and PM10 do get some attention, black carbon does not.

“Most studies have focused on PM2.5 and NO₂, but we need much more attention on black carbon, given its major role in both health harms and climate change. These pollutants mainly come from car exhaust, power plants, industry, and diesel engines,” said Khreis, who added that black carbon or soot is sometimes smaller than PM2.5 and sticky.

“If that small sized black carbon particle sticks inside your lung or inside any other capillary in your body, that can create more damage than any other bigger sized particle,” Balyan explained.

Limited evidence from Global South

Most of the world’s population breathes in polluted air.

Of the 51 studies that were examined, 20 (39%) were done in Europe and 17 (33%) in North America, representing more than half of the overall evidence.

“Most of the data comes from high-income countries, and often from White, urban populations. That means we’re missing critical evidence from low- and middle-income countries, and from groups that face the highest exposures because of structural inequalities,” Khreis said.

She added that the global burden is probably underestimated and the risk in some groups within urban areas is concealed.

“It is likely that the deleterious impact of PM2.5 on dementia risk is mediated by other factors such as overall health status, specific co-morbidities, exercise and nutrition. Hence it is important to generate data from geographically and socioeconomically diverse populations across the world to develop a more customized and holistic framework for risk reduction interventions,” said Vaibhav A. Narayan, PhD, head of innovation and strategy for the Davos Alzheimer’s Collaborative, which is supporting a “Global Cohorts Programme” with other research partners to generate such data in low-resourced settings.

A majority of the world’s most polluted cities are in the developing countries. In 2024, 49 of the world’s most polluted cities were in Asia and one in Africa, according to data from IQAir, a Swiss air monitoring company.

But only 12 studies (24%) from Asia were included and none from Africa or Latin America. Two (4%) others were from Oceania (both in Australia).

Some of the earliest studies linking air pollution and impacts on the brain were conducted in Mexico City. Dogs living in polluted environments in Mexico City had more neurodegeneration than dogs living in cleaner environments outside Mexico City, according to one study. Similar studies were also done with children going back to 2008.

Evidence from India also suggests that those using polluting sources of cooking fuel were at a higher risk of cognitive impairment, especially rural women, given that they tend to have higher exposure to polluting cooking fuels like firewood.
“A majority of studies are currently from Europe or North America, or China, and we need a broader global evidence base representing other regions,” Pant said.

“Having said that, with the available evidence, the case for addressing air pollution to help reduce the dementia burden at the population level is strong,” she added.

A ‘modifiable risk factor’ for dementia

WHO’s outgoing director of the Department of Environment, Climate Change and Health, Dr Maria Neira, is widely credited with increasing awareness about air pollution.

The Lancet Commission has included air pollution as a modifiable risk factor for dementia in 2024, as it is possible to improve air quality.

Balyan sees some positive trends in addressing air pollution, including more awareness, more funding for research on air pollution and more collaboration.

“Now engineers and doctors are collaborating, they are working together. So that kind of collaboration has also increased which is leading to more number of studies. International collaboration has also increased because of this easy to work online system,” she said.

Dr Maria Neira, the outgoing director of the World Health Organization’s (WHO) Department of Environment, Climate Change and Health since 2005, is widely credited with increasing awareness about the impact of air pollution on health.

Image Credits: WHO, U.S. Environmental Protection Agency (EPA), WHO, US Mission Geneva .

China’s representative at the World Health Assembly in May.

China has suggested that the access pharmaceutical manufacturers get to information about dangerous pathogens should be “contingent” on their home country being a party to the Pandemic Agreement recently adopted by the World Health Assembly (WHA).

This will encourage World Health Organization (WHO) member states to ratify the agreement in their respective countries, but it is also a dig at the United States, which has pulled out of the WHO, under whose auspices the agreement was negotiated.

China’s proposal is part of a list of suggestions by WHO member states ahead of a meeting of the Intergovernmental Working Group (IGWG) on 15 September.

At its first meeting in July, the IGWG appealed to member states for suggestions about what should be included in the major outstanding issue of the agreement – an annex on a pathogen access and benefit sharing (PABS) scheme.

Disagreement about PABS has long been the main obstacle to the pandemic agreement – so much so that it was kicked down the road by the WHA in May. The WHO has entrusted the new body, the IGWG, to thrash out how the scheme will work before the next WHA in 2026. 

Once this has been done, the pandemic agreement will be complete and ready for country ratification.

Essentially, the PABS scheme will regulate how the genetic sequencing and other information about “pathogens with pandemic potential” is shared. Many countries, particularly in the global South, want any sharing that they do to be on condition that they get benefits from products that manufacturers make as a result.

Restricted access

China proposes that the annex defines the scope of eligible participants in PABS and the modalities of their engagement. For manufacturers, the annex should “specify qualification criteria, boundaries of liability, and both financial and technical benchmarks, and make these contingent on whether their home state is a party to the Pandemic Agreement”, says China.

It also proposes that the WHO establish a “tracing and tracking mechanism” for PABS materials based on “transparency and traceability”. 

However, it suggests restricted access to high-risk information with “a mechanism that tracks both the chain of custody of biological samples and the linkage to associated data”, based on the Influenza Virus Traceability Mechanism (IVTM).

Russia also wants restricted access as some pathogens which could become “weapons of mass destruction”. It suggests that “pathogens with pandemic potential” should not be transferred to countries that lack “national biosafety and biosecurity regulations and certified laboratory facilities and personnel”.

Legally binding contracts

The Africa Group’s proposal reiterates its longstanding position that the scheme should be based on both “rapid and timely access” to PABS materials and sequence information and the “rapid, timely, fair and equitable sharing of benefits” arising from this information. 

Africa envisages that the WHO will have individual legally binding contracts with manufacturers that join PABS, the terms of which will be public.

During a “pandemic emergency”, these manufacturers will make available to the WHO “20% of their real-time production of safe, quality and effective vaccines, therapeutics, and diagnostics for the pathogen causing the pandemic emergency”. At least 10% of this will be free, and the remaining 10% at “affordable prices”.

Australia, the United Kingdom, Norway, Canada, and New Zealand also support the 20% allocation to WHO.

Africa also wants the contracts with manufacturers to include annual monetary contributions to the PABS system “to support initiatives for transfer of technology and know-how, research and development, scientific and research collaborations, and laboratory capacity strengthening”.

Pandemic simulation exercise

The European Union’s proposal simply notes five areas that PABS needs to cover, with the “benefit-sharing parameters” based on contracts with participating manufacturers that demarcate issues such as the “set-aside quantities” and donations (to the WHO) of vaccines, therapeutics and diagnostics developed.

Japan submitted a diagram that succinctly presents issues to be covered.

Switzerland, in collaboration with the WHO Collaborating Centre at the Spiez Laboratory, proposes to organise “a simulation exercise to support the negotiations of the annex”. 

The one-day exercise would test the “practical feasibility and operational functionality of a potential PABS Mechanism by simulating a realistic pandemic emergency scenario”. 

An informal IGWG meeting is planned for 12 September, with the next formal meeting from 15-19 September.

The IGWG Bureau, the administrative body overseeing the talks, is also compiling a list of experts to assist with negotiations. These will also be circulated to member states.

Experts are essential for this part of the talks, which are complex given that the annex will need to harmonise with several international agreements covering intellectual property and trade, as well as the Nagoya Protocol, which determines how to share the benefits arising from the utilisation of genetic resources fairly and equitably.

Indian Prime Minister Narendra Modi at the launch of the government health insurance scheme in 2018. However, the scheme has run into problems over non-payment to private hospitals.

ROHTAK (Haryana), India – When 22-year-old Sunita* rushed her father to a private hospital in for a cardiac emergency earlier this month, she expected her government health insurance scheme, Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (known as PM-JAY), which promises to cover hospital expenses up to ₹5 lakh (around $5,725) per family, would spare her family from crushing debt.

Instead, she was told that the hospital in Haryana State had stopped admitting scheme patients over months of unpaid dues from the government. The facility is one of 650 private hospitals across Haryana that have suspended all PM-JAY services in protest over ₹490 crore ($59 million) in pending reimbursements. 

According to the Haryana Health Department, the unpaid dues date back at least six to nine months. The abrupt halt has cut off up to 18 million low-income residents from private-sector surgeries, dialysis, cancer care and other critical treatments.

Sunita’s family, who earn barely ₹10,000 ($114) a month from farm labour, had to admit her father to a smaller facility with limited cardiac services. 

“We had no choice but to borrow money,” she said. The bill ran into several thousand lakhs, “an amount my father or any of my relatives had never seen together in our lives.”

National promise under pressure

 The suspension in Haryana is the latest stress fracture in India’s flagship public health insurance programme, launched in by President Narendra Modi 2018 to provide cashless secondary and tertiary care to the poorest 40% of the population. Nationally, the scheme claims to cover more than 500 million people, with over 25,000 member hospitals.

It also comes as a recent Swiss Re Institute report warns that India faces one of the world’s largest health protection gaps, with out-of-pocket expenses accounting for over half of total health spending. 

The report cautions that without reliable public health financing, millions could fall into poverty due to medical costs  directly undermining the government’s universal health coverage goals. 

A recent Indian study found that nearly 28% of households incurred “catastrophic expenditure” on inpatient healthcare alone in 2024. This is defined as health spending that is over 10% of household’s capacity to pay. 

Haryana’s deadlock with private hospitals highlights a deeper problem: while PM-JAY has been touted as the world’s largest government-funded health insurance scheme, its rollout across states has been uneven, plagued by delayed reimbursements, under-enrolment of private providers, and allegations of fraud.

A private hospital in Rohtak, India. Some 650 hospitals in Haryana State have suspended services to government health insurance members over non-payments.

And the cracks are not limited to Haryana. In Jammu and Kashmir, where healthcare infrastructure is weaker and private hospitals are fewer, delayed claim settlements and restrictive empanelment rules have left many patients travelling hundreds of kilometres for treatment, sometimes across state lines.

The region has fewer than 130 empanelled private hospitals compared to Haryana’s 650.

Months of unsuccessful negotiations

In Haryana, the private hospitals and representative bodies began their refusal to accept members with the government insurance scheme in early August after months of unsuccessful negotiations with the state health department over pending dues, the Indian Medical Association (Haryana) told the Hindustan Times. 

Hospitals say they cannot sustain payroll, utilities, medicine purchases and consumables when reimbursements are delayed for six to nine months.

Dr Suresh Kumar, a doctor based in Haryana, said private facilities could no longer sustain operations without timely reimbursements. 

“We have to pay salaries, electricity bills, buy medicines and consumables — all on time,” he told Health Policy Watch. “If the government delays payments for six to nine months, we simply cannot function.”

Hospital administrators also argue that  the national Health Benefit Package (HBP) rates for procedures under AB-PMJAY are often outdated and may not match rising input costs. 

The Health Benefit Package documents list package prices for procedures, while the audits show that actual costs for complex surgeries frequently exceed package rates in many private hospitals, creating a shortfall for providers

The state health agency, however, has accused some hospitals of inflating bills and submitting dubious claims. Officials say they are conducting audits to weed out fraud before releasing payments, which has contributed to the delays.

Patients in limbo

While the standoff drags on, patients are bearing the brunt.

Ramphal*, a 56-year-old construction worker in the Rohtak district, had postponed a hernia surgery for three months because the nearest government hospital has a waiting list and private options are off-limits. 

“The pain is constant,” he said. “But without Ayushman, I can’t afford the operation.”

For Sunita’s father, the consequences were immediate and severe. The smaller hospital where he was admitted lacked advanced cardiac care, forcing a risky makeshift treatment. The family borrowed from relatives and neighbours, sinking into debt that could take years to repay.

Public hospitals, meanwhile, are reporting a surge in patient load since the suspension, with longer wait times and overstretched staff.

A rural hospital in Paud in western India.

Parallel crisis in Jammu and Kashmir

In Jammu and Kashmir, the AB-PMJAY rollout has faced its own hurdles – even without a mass suspension.

The region, which joined the scheme in December 2018, has only a limited number of empanelled private hospitals, most in the Kashmir Valley.

The majority of private clinics are not part of the programme, citing cumbersome empanel procedures and low reimbursement rates.

Patients in rural districts often travel to Srinagar or even to Punjab for eligible treatments. Delayed claim settlements — sometimes taking more than six months — discourage providers from participating.

 Dr Parvez Ahmad, who runs a mid-sized poly-clinic in Baramulla, said the uncertainty has forced private hospitals  to limit the number of Ayushman patients. 

“The paperwork is heavy, the payments are slow, and the rates don’t match actual costs,” he said. “We want to help poor patients, but we can’t run at a loss.”

For patients like 45-year-old Naseema from Kupwara, the gaps in coverage are stark. She was diagnosed with breast cancer last year but had to travel over 100 km to Srinagar for surgery under PM-JAY, a trip that drained her savings and left her physically exhausted.

Fragility of public-private model

Health economists say the twin crises in Haryana and Jammu and Kashmir illustrate the fragility of India’s public-private partnership model in healthcare.

“PM-JAY is heavily dependent on private hospitals, but the government’s purchasing power is undermined when reimbursements are delayed,” said public health expert Dr Indu Bhushan. “Without a predictable payment system and periodic rate revisions, private participation will keep shrinking.”

The Swiss Re Institute’s analysis echoes these concerns, warning that India’s heavy reliance on out-of-pocket payments – currently about 50% of total health expenditure – risks reversing poverty reduction gains. It estimates that the health protection gap could reach $200 billion by 2033 if current trends continue.

In Haryana, the government has promised to clear dues by October and review package rates, but private hospitals remain sceptical. In Jammu and Kashmir, officials say they are working to streamline empanelment and speed up claims processing, but no concrete timeline has been announced.

High stakes for Universal Health Coverage

India’s 2017 National Health Policy sets a target of reducing catastrophic health expenditure to 25% of households by 2025. But reality suggests that, without structural fixes to schemes like AB-PMJAY, that goal may be out of reach. 

According to a 2024 meta-analysis, the pooled incidence of catastrophic health expenditure stands at 30% of Indian households – 5% higher than the 25% policy target.

Moreover, a 2024 study of inpatient healthcare found that 28% of households incurred catastrophic health expenditure. 

On average, inpatient care accounted for 11% of monthly household consumption, underscoring how deeply hospital costs strain family budgets.

While government spending on health is gradually rising, out-of-pocket payments remain stubbornly high. 

Recent National Health Accounts data shows that government health expenditure rose from 1.13% to 1.84% of GDP between 2014–15 and 2021–22, but still leaves households shouldering a significant burden.

Together, these figures paint a stark picture: the policy target of reducing catastrophic burden to 25% by 2025 is not being met, and public financing remains limited despite slow gains.  This means that households are still paying a major share of healthcare costs themselves, raising serious concerns about the financial protection that the scheme offers.

For Sunita’s family, the lofty targets mean little compared to the daily reality of debt and uncertainty. “If Ayushman doesn’t work, where will poor people go?” she asked.

As the impasse in Haryana continues and patients in Jammu and Kashmir remain underserved, the larger question looms: can India’s flagship health insurance programme truly deliver universal health coverage, or will it remain a patchwork safety net that frays when it is needed most?

*Patients asked for their surnames not to be used.

Image Credits: PMO India, Disha Shetty.

Ahmad, 15, and his younger brother Sahil, 12, at the Torkham border between Pakistan and Afghanistan with their family, after returning from Pakistan.

Afghanistan’s fragile healthcare system is at breaking point under the strain of hundreds of thousands of Afghans deported from Iran and Pakistan over the past few months, many in urgent need of medical care.

This follows the decision by both Pakistan and Iran to repatriate Afghans, even those with refugee status in the case of Pakistan. Earlier this year, the UN High Commission for Refugees estimated that there were over 3,5 million Afghan refugees in Iran and 1,7 million in Pakistan.

Between January and 13 August, some 1.86 million Afghans have been returned from Iran and over 314,000 from Pakistan, bringing the total returns to over two million people over the past eight months alone.

Over eight million Afghans have fled their country over decades of war, but those in Iran and Pakistan are being deported to an uncertain future.

At Afghanistan’s Islam Qala border crossing with Iran, the human cost is stark: toddlers with sunken cheeks and dehydrated skin, elders bent over in coughing fits, heavily pregnant women staggering through the dusty camps, some giving birth amid chaos.

For the past many months, overwhelmed border Afghan health teams have confronted the same cycle of illnesses almost daily. Health workers say the illnesses surging through the camps are a predictable fallout of forced displacement colliding with an already overwhelmed healthcare system.

“Commonly reported health issues among returnees include trauma, malnutrition, infectious diseases such as acute watery diarrhoea and acute respiratory infections, and mental health problems,” according to the World Health Organization (WHO).

The sweltering camp for deportees reeks of over-flowing latrines and antiseptic, a grim reminder that these makeshift checkpoints have become the country’s first, and often only, line of defense against disease outbreaks.

In a torn tarpaulin’s thin shade, Zaher Qayumi, a father of five from Badghis Province, shields his children from the relentless sun. Just 10 days earlier, after five years in Iran, his nine-member family was abruptly expelled from Tehran. His children suffer from diarrhea and dizziness, their faces flushed with heatstroke.

“The situation here is terrible. Medicines, even for simple pain or diarrhea, are almost impossible to find,” Qayumi told Health Policy Watch. 

“Iranian authorities are expelling everyone. The elderly and children suffer the most. People have no means and resources. Everyone is sick.”

It is extremely difficult and complicated to navigate for returnees to access what little public health services there are, and Qayumi’s words reveal the human face of the slow-motion public health emergency playing out across the desert border.

A WHO-supported disease surveillance support team conducts a health education session for returnees at Islam Qala border crossing.

Plea for immediate assistance

Stephanie Loose, UN Habitat head for Afghanistan, told a recent press briefing in Geneva that families are arriving after days of travel in blistering heat, enduring overcrowded tents and nights without enough food, water, or shelter. 

“The real challenge is still ahead of us… people need access to basic services, to water, to sanitation, and overall, they do need livelihood opportunities for having a long term perspective and for also allowing them to, you know, lead their lives in dignity and to support their families,” said Loose.

Afghanistan’s humanitarian system is in free-fall. The country’s 2025 aid plan, valued at around $2.4 billion, is only 12% funded, according to the UN.

Aid agencies warn they are already cutting food, health, and shelter support, leaving millions at risk. UN officials are urging donors to act immediately, stressing that without swift contributions, lifesaving operations could collapse, plunging vulnerable communities into further desperation.

“At [Islam Qala’s] zero-point clinic, returning families arrive dehydrated, malnourished, and sick with respiratory and diarrheal diseases,” said Dr Noor Ahmad Mohammadi, head of the WHO-supported clinic. “We treat hundreds of children daily, most never vaccinated. Immediate action is critical to prevent rapid outbreaks.”

The clinic provides outpatient care and polio vaccinations, seeing roughly 200 patients and vaccinating 100 children under 10 each day. But with thousands crossing daily, their modest resources are overwhelmed.

UNHCR has expressed concern that many Afghans, regardless of status, “face serious protection risks in Afghanistan due to the current human rights situation, especially women and girls”.

Forgotten crisis

Afghanistan’s health system, hollowed out by decades of conflict, chronic underfunding, and the exodus of medical professionals following the Taliban’s rise to power in 2021, was already on the brink of collapse before the deportations began.

“Afghanistan is facing a deepening humanitarian crisis fuelled by a deteriorating human rights situation, prolonged economic hardship, recurring natural disasters and limited access to critical services. The large-scale returns of over 2.1 million Afghans from Iran and Pakistan in 2025 have further exacerbated the situation,” said UNHCR in a statement.

Aid agencies warn that as many as three million Afghans could be pushed back by the year’s end, raising the risk of a preventable public health disaster without urgent scale-up of clean water, vaccinations, and emergency care.

“The crisis is forgotten by much of the world,” said Nicole van Batenburg of the International Federation of Red Cross and Red Crescent Societies in a statement. “Local health systems are simply not equipped to cope.”

Many families were given mere hours to leave homes in Iran or Pakistan, abandoning belongings, medication, and any sense of security. Children arrive with fevers, diarrhea, scabies, and trauma; parents carry the weight of uprooted lives.

By spring 2025, more than 200 health facilities across Afghanistan had closed or suspended services due to lack of funds, the WHO reports. 

Dr Edwin Ceniza Salvador, WHO’s Afghanistan representative, warns that 80% of supported health services could shut down without fresh funding.

“Mothers are unable to give birth safely, children missing lifesaving vaccines, and more preventable deaths every day,” he said.

In a corner of the border camp, Zohra*, a 28‑year‑old pregnant woman, lay on a thin mat, clutching her stomach. She was seven months pregnant when her six-member family was forcibly expelled from Mashhad in Iran.

“We were told to leave within hours. I couldn’t procure the medicines I needed even before this ultimatum as I feared arrest going to the hospitals,” she said in a faint voice. “The journey was long and hot. I thought I would lose my baby on the road.”

By the time she reached the Afghan border, Zohra was severely dehydrated and showing signs of early labour. Border clinic staff managed to stabilise her, but they warned that complications could turn deadly if she cannot access a proper hospital in time.

“I wish my daughter comes to this world alive and healthy, but I worry what kind of place my children would live and grow in Afghanistan”, Zohra said.

An earlier wave of deportations from Pakistan has already strained the Afghan healthcare system. Since late 2023, tens of thousands of Afghans, many of whom had lived in Pakistan for decades, have been forced to cross back to Afghanistan with little more than what they could carry.

The UN estimates that in this year alone, at least 314,000 Afghans had been returned from Pakistan by the end of July, often arriving with untreated chronic conditions, respiratory infections, and severe malnutrition, while vaccination records are frequently missing.

No medicine or food

Halima Bibi, an elderly diabetic woman, had lived as a refugee in Pakistan for years before she was expelled from the outskirts of Islamabad with her son’s 10-member family. Her health situation embodies the health crisis in Afghanistan.

“My feet are swollen, and I can barely stand,” she said. “I haven’t had my medicine or proper food for days. We had to wait anxiously for days to get an extension for our stay in Pakistan, but they forced us to leave without any consideration or time to prepare.” 

Across Afghanistan’s border, in provinces like Nangarhar where Bibi lives, clinics and hospitals are swamped, lacking the resources to meet the urgent needs as well as management of chronic diseases like diabetes. 

Halima is fearful that insulin medicine would not be easily available for her in Afghanistan and this will cause her serious health complications. 

The Taliban’s deputy minister for refugees and repatriation, Abdul Rahman Rashid, has publicly rebuked host countries for the mass expulsions, describing the removal of Afghans as a “serious violation of international norms, humanitarian principles, and Islamic values.”

“The scale and manner in which Afghan refugees have been forced to return to their homeland is something Afghanistan has never before experienced in its history,” Rashid told a press conference in Kabul last month.

Back at Islam Qala border crossing, the transit clinic operates 24/7 where the returnees arrive with health conditions that are manageable in a well-resourced hospital, but often life-threatening here. Women and girls face particular concerns over movement restrictions and access to healthcare.

As summer heat intensifies and thousands continue to arrive daily, aid workers warn the window to prevent a full-blown humanitarian and public health catastrophe is closing fast.

Image Credits: UNHCR/ Oxygen Empire Media Production, UNHCR, WHO Afghanistan.

A protest against closure of the US Agency for International Development (USAID) in February

US non-profit groups have vowed to fight on after losing their court bid this week to compel the Trump administration to restore Congress-approved foreign aid it had stopped in January.

A three-judge panel of the US Court of Appeals ruled 2-1 to overturn a District Court ruling that compelled the US government to restore some $10 billion in foreign aid authorised by Congress for fiscal year 2024, before Trump assumed office.

According to Wednesday’s ruling, only the Government Accountability Office, Congress’s independent watchdog, can challenge the president’s actions in court in terms of the Impoundment Control Act.

But Judge Florence Pan issued a scathing dissenting opinion: “A President defies laws enacted by Congress without any legal basis, and the court holds that he has merely violated a statute, that the Constitution is not even implicated, and that there is no judicially enforceable cause of action to challenge his conduct. 

“By failing to rein in a President who ran roughshod over clear statutory mandates, the court evades its constitutional responsibility to delineate the obligations and powers of each branch of our government,” added Pan.

She also accused her colleagues, Judges Karen Henderson and Gregory Katsas, of derailing “the ‘carefully crafted system of checked and balanced power’ that serves as the ‘greatest security against tyranny – the accumulation of excessive authority in a single Branch’.” 

‘Seek permanent relief’

On 10 February, Public Citizen filed the lawsuit on behalf of AVAC, a global HIV advocacy group, and the Journalism Development Network, seeking emergency relief from a funding freeze put in place by an executive order issued the day that Trump took office. 

Public Citizen attorney Lauren Bateman described the ruling as “a significant setback for the rule of law and risks further erosion of basic separation of powers principles”. 

Bateman said the lawsuit “will continue as we seek permanent relief from the administration’s unlawful termination of the vast majority of foreign assistance”, adding that “countless people will suffer disease, starvation, and death from the administration’s unconscionable decision to withhold life-saving aid from the world’s most vulnerable people.” 

AVAC executive director Mitchell Warren said in a statement that the court ruling “hands the administration another victory in their intentional effort to destroy decades of progress in global development, diplomacy, public health and human rights”.

“Time and again, this administration has shown their disdain for foreign assistance and a disregard for people’s lives in the US and around the world,” added Warren.

“More broadly, this decision, which we will appeal to the extent possible, further erodes Congress’s role and responsibility as an equal branch of government, and the majority opinion makes the court complicit.”

The Trump administration has closed the US Agency for International Development (USAID), attempted to slash the budget of the President’s Emergency Plan for AIDS Relief and withdrawn from the World Health Organization.

The US Senate recently agreed to exempt PEPFAR from a planned $400 million cut, proposed as part of a $9.4 billion rescission package put forward by Trump.

But this relief is likely to be short-lived as US State Department officials are developing a plan to transform PEPFAR from an entity that tackles HIV to one that is broadly focused on protecting and promoting “American interests”, according to the New York Times.

The new entity would be based on bilateral agreements with low-income countries focused on diseases that could threaten the US.

Dr Jirair Ratevosian, a global health expert at Duke University and previous PEPFAR chief of staff, said that the Trump administration has “made it very clear that they want to carry on with aggressive transition planning” for PEPFAR.

“Transition planning is not a bad idea, but it must be done right, with timetables, developing indicators, matching government buy-in, getting community input, etc,” Ratevosian said.

Warren said that the court decision “exacerbates an already grave humanitarian crisis” and urged policymakers and the courts to “act urgently to reverse this dangerous precedent”.

“The health and lives of millions – not to mention the underpinnings of our democracy – hang in the balance.”

Image Credits: Reuters Youtube.

At 7am Friday morning, the plastics negotiations were called off in Geneva after countries fail to reach agreement on the basics. No advances in the text were made over the 12-day talks.

GENEVA — Negotiations over a United Nations (UN) treaty to combat the plastic pollution crisis ended in failure early Friday morning, as 183 nations were unable to bridge vast divides over production limits, toxic chemicals and financing after three years of diplomacy.

Norway officially announced the failure at 7am Geneva time after a final overtime negotiation session lasting over 24 hours.

Denmark, co-chair of the High Ambition Coalition supported by around 100 countries, said it was “truly sad to see that we will not have a treaty to end plastic pollution here in Geneva”, adding that the coalition has “clearly and repeatedly stated that we need an international, legally binding instrument that effectively protects human health and the environment from plastic pollution.”

A treaty that is able to fulfil this mandate must “at a minimum address the full life cycle of plastics, the “unsustainable consumption and production of plastics” and include “global measures and criteria on plastic products and chemicals in products,” added Denmark, which also raised the possibility of voting.

The talks were themselves an extension following December’s failed summit in Busan, South Korea. Rules requiring unanimous agreement kept the process in stalemate throughout the 12-day session.

Both draft texts presented by negotiation chair Luis Vayas Valdivieso of Ecuador were rejected by all parties. The chair’s approach, predicated on placating the lowest-ambition nations, proved insufficient even for those countries.

The petrochemical producing bloc (which calls itself the “like-minded countries”) led by Saudi Arabia and flanked by the United States (US), Russia, India, Malaysia and others, rejected even hollowed-out texts that had angered high-ambition countries by removing all mentions of chemicals, production limits, health, climate emissions, and mandatory finance. 

Further negotiations will reconvene at an undetermined date and location, based on the draft text from Busan, leaving the agreement no closer to completion than six months ago. 

Many delegates questioned the purpose of the Geneva talks, as the outcome appeared predetermined with no apparent strategy to break the deadlock. If the rules of engagement requiring unanimous agreement remain unchanged, it is uncertain whether high-ambition nations or civil society will attend future talks.

Defeat for multilateralism

UNEP executive director Inger Anders, speaking after the collapse of the talks in Geneva.

Speaking outside the assembly hall after the collapse, Inger Andersen, executive director of United Nations Environment Programme (UNEP) said: “Tell me of a treaty that has been done, in a shorter time, and then we can discuss. Would I have liked this in two years? Absolutely. 
At this point, it is critical that we take some time first to sleep and then to reflect and then to regroup. In the end, this is a member state’s lead process, and we from the United Nations are here to support it.

“I believe that everybody is very disappointed. However, multilateralism is not easy. What I can say about the future, I can’t say, we literally just walked off the floor.”

The breakdown represents a significant defeat for multilateralism at a time when its capital, Geneva, is facing mounting challenges to its value as a global diplomatic capital. 

It is also a blow for UNEP, which spent millions organising the talks but serves only as a mediator without the ability to sway outcomes, which are decided by nation-states.

“We cannot hide that the European Union and its member states had higher expectations,” EU Environment Commissioner Jessika Roswall said in a statement. 

“We came to conclude a global plastics treaty here in Geneva. We have confidence in the science that impels us, confidence in the people that pushed us, confidence in a majority of countries of both developing and developed that are aligned.

“That is what we fought for. We have not managed to get there.” 

The failure exposes a fundamental rift in visions for global plastics governance between more than 130 countries seeking legally binding measures to curb plastic production and the powerful bloc of oil-producing states intent on protecting the financial benefits of the plastics boom.

With plastic production expected to triple by 2060, according to OECD projections, and 99% of plastics made from fossil fuels, the sector represents a crucial revenue stream for petrostates as traditional energy demand shifts toward renewables.

“I am disappointed, and I am angry,” said French Environment Minister Agnès Pannier-Runacher following the collapse. “A handful of countries, guided by short-term financial interests rather than the health of their populations and the sustainability of their economies, blocked the adoption of an ambitious treaty against plastic pollution.”

Plastic
Most plastics that are produced end up in landfills in poorer countries.

“This was never going to be easy – but the outcome we have today falls short of what our people, and the planet, need,” said Surangel Whipps Jr, President of Palau and chair of the Alliance of Small Island States (AOSIS), many of whom are overwhelmed by plastic pollution and stand to lose much of their territories to climate-related rising sea level.

“Still, even after six rounds of negotiations, we will not walk away. The resilience of islanders has carried us through many storms, and we will persevere – because we need real solutions, and we will carve pathways to deliver them for our people and our planet.”

The global petrochemical industry, valued at $638 billion in 2023, is expected to be worth $838 billion by 2030. Saudi Aramco, the state-owned oil company, plans to channel about one-third of its oil production to plastics and petrochemicals by 2030. Petrochemicals make up 82% of Saudi foreign exports critical to its government budget. 

“The scientific and medical evidence is overwhelming: plastic kills. It poisons our oceans, our soils, and ultimately, it contaminates our bodies.”

Production off the table 

The central battle throughout negotiations centered on whether the treaty would address plastic production or focus solely on waste management and recycling, as advocated by the petrochemical bloc and its allies.

These nations insist that the plastics crisis can be solved through better waste management, despite technological limitations that have kept global recycling rates below 10% after decades of research and billions spent to improve recycling technologies. 

The nations pushing recycling as the solution have failed at it themselves. Saudi Arabia recycles just 3-4% of its plastic waste, Russia between 5-12%, and the US only 5-6%, according to OECD data.

The like-minded nations successfully blocked any mention of plastic production limits in the draft texts. They also removed references to climate change, emissions, fossil fuels, and petrochemicals, despite plastic production releasing more than two gigatons of CO2 annually.

If the plastics industry were a country, it would be the world’s fifth-largest greenhouse gas emitter. At projected growth rates, plastics alone could consume a quarter of the remaining carbon budget to meet the Paris Agreement’s 1.5°C target.

Health impacts sidelined, science ignored 

The infiltration of plastics and microplastics into air, rain, oceans, ecosystems and human organs has been linked to cancer, infertility, cardiovascular disease and hundreds of thousands of premature deaths annually.

A Lancet study released during the talks estimated the cost of just three plastic chemicals at $1.5 trillion per year across 38 countries. One chemical of the 16,000 used in plastics, BPA, was associated with 5.4 million cases of heart disease and 346,000 strokes in 2015. 

“Toxics and microplastics are poisoning our bodies, causing cancer, infertility, and death, while corporations keep profiting from unchecked production,” said Giulia Carlini, senior attorney at the Center for International Environmental Law (CIEL). “The science is undeniable. Yet here, it has been denied and downplayed.”

Complete safety information is missing for more than two-thirds of the chemicals used in plastics. Three-quarters have never been properly assessed for human health impacts. Just six per cent of all plastic chemicals are regulated under multilateral environmental agreements.

Yet despite the science, petrochemical states continued to argue that health impacts fall beyond the treaty’s mandate, insisting that regulation should be governed by the WHO.

Many of the same countries arguing health is outside the scope of the plastics treaty, including Russia and Iran, held the opposite position at the latest World Health Assembly, contending chemicals should not be regulated by World Health Organization (WHO) due to UNEP’s mandate. 

“The inability to reach an agreement in Geneva must be a wakeup call for the world: ending plastic pollution means confronting fossil fuel interests head on,” said Graham Forbes, head of the Greenpeace delegation to the treaty negotiations.

“The vast majority of governments want a strong agreement, yet a handful of bad actors were allowed to use process to drive such ambition into the ground,” Forbes added. “The plastics crisis is accelerating, and the petrochemical industry is determined to bury us for short-term profits.”

Petrochemical industry influence

At least 234 fossil fuel and petrochemical lobbyists attended the Geneva talks, exceeding the combined delegations of the EU and its 27 member states. They outnumbered expert scientists by three to one.

The process itself faced criticism for its opacity, with many meetings closed even to national delegations. Chair Valdivieso, Ecuador’s ambassador to the UK, was roundly criticised for his handling of negotiations, the vast majority of which occurred behind closed doors.

Civil society groups, including indigenous peoples, waste pickers and frontline communities who travelled from around the world, found themselves actively sidelined

In the closing plenary, only the Youth Plastic Coalition was allowed to speak before the US and Kuwait cut proceedings short, silencing the rest of civil society.

“This is the real health crisis,” Kuwait’s delegation said, alluding to the long night faced by negotiators as the clock struck 9am. 

Less developed nations stood up to industry and rich country pressure that had cornered them behind the scenes with economic threats, yet even this resistance could not break the deadlock.

The consensus requirement allowed low-ambition countries to “hold the entire process hostage,” as Ethiopia’s delegation put it.

“This INC was doomed from the start,” said Andrés Del Castillo, senior attorney at CIEL. “Poor time management, unrealistic expectations, lack of transparency, and a ministerial segment with no clear purpose.”

Image Credits: Stefan Anderson, Photo by Hermes Rivera on Unsplash, UNEP.

Africa CDC Director General Dr Jean Kaseya (centre) visiting DRC to assist with its mpox outbreak

African countries worst affected by mpox have rapidly expanded their diagnostic capacity, with more laboratories and better-trained health workers, said Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC).

The Democratic Republic of Congo (DRC), the epicentre of the mpox outbreak, has increased its laboratories from two in January 2024 to 69, Kaseya told a media briefing on the first anniversary of the declaration of mpox as a Public Health Emergency of Continental Security (PHECS).

 

Mpox has compelled the DRC to rapidly expand its health capacity.

Despite mpox vaccine shortages, some 886,000 people have also been vaccinated in 12 countries, he added.

Mpox has affected 24 African countries, with over 97,000 suspected cases and almost 600 deaths. But weak diagnostics mean fewer than a third of cases( 29,849) and deaths (197) were confirmed.

Conflict and poor infrastructure are affecting the DRC’s ability to identify and treat cases, which accounts for most of the untested cases. 

Other high-burden countries – Sierra Leone, Burundi and Uganda – have been able to test almost all their suspected cases.

Africa CDC and the World Health Organization (WHO) have coordinated countries’ responses via an incident management support team (IMST), which has trained 3,000 health workers on case management.

The IMST has developed continental Mpox Preparedness and Response Plans and co-led the implementation.

“Our collective efforts have been crucial in strengthening measures for an effective response,” said Dr Otim Patrick Ramadan, WHO Africa’s programme area manager for emergency response. “It is critical to sustain what works, which includes rapid case detection, timely targeted vaccination, strong laboratory systems, and active community engagement.”

Professor Yap Boum, deputy incident manager for Africa CDC, said: “With limited resources, there is a critical need to be more efficient which means working as one team, with one plan budget and monitoring framework,” said

Mpox is declining on the continental and Africa CDC’s independent expert panel will soon decide whether to suspend the PHECS, said Kaseya.

However, challenges persist including imited access to vaccines, competing emergencies, funding gaps, inadequate access to care, and stigma and the conflict in eastern DRC, according to WHO Africa in a media release on Thursday.

“Our priorities for the next six months are to  expand community-based surveillance in high-risk areas, continue to procure and distribute essential supplies to hotspots, support the integration of mpox response into other health programs for sustainability, support targeted vaccination and advocate for more funding for vaccine deployment,” said Otim.

However, the infrastructure that has been set up to address mpox is also being used to address another health emergency: cholera. 

Twenty-three countries are facing cholera outbreaks, usually caused by a lack of clean water,  which are being fanned by “humanitarian crises and natural disasters”.

So far, over 220,000 cholera cases have been recorded this year – already close to the case load of 254,000 for the whole of 2024.

By month-end, Zambia will host a meeting on cholera to develop a common continental approach, said Kaseya.

Africa CDC is also encouraging countries to integrate their HIV and mpox responses, testing people for both diseases. People with HIV are more susceptible to mpox, which can also be sexually transmitted.

Health financing

When asked whether any African group was taking forward the proposal that tourists to the continent should be charged a tax levied via airlines to help cover the cost of healthcare, as suggested by last week’s summit on African health sovereignty, Kaseya simply deferred to Rwandan President Paul Kagame.

“The meeting in Ghana … is just a continuity of what is already done, because there is, there is nothing new that will come there if it was not discussed in AU,” said Kaseya. “Our champion for health financing is President Kagame. And in Africa, we like to respect to that. For the next steps, if there is a leader who must talk about health financing and bring other leaders together, it is  President Kagame.”

However, Kaseya reiterated that the solutions to the funding crisis lie in countries allocating more domestic resources to health; innovative solutions including the airline tax and taxes on unhealthy products ,and blended finance. The DRC is taxing all imported goods and allocating some of that revenue to health, he added.

There has been a 40% reduction in development aid to the continent in the past two years – the steepest cuts taking place over the past eight months since US President Donald Trump assumed office.

“We have a number of areas of engagement with the US , and we hope that that we can get a positive outcome from this engagement,” said Kaseya.

 

Image Credits: Africa CDC.

A new draft text of the UN Plastics Treaty was met with universal outrage and rejection. Less than 48 hours remain before the deadline for 184 nations to agree on a treaty.

GENEVA – A new draft of the global plastics treaty published Wednesday found a clever solution to answering the difficult questions facing nations seeking the historic treaty: delete them from the text.

The long-awaited draft arrived at a tense moment in negotiations over what many hoped would be a watershed treaty to address the crisis of plastic pollution choking the environment and harming human health.

As delegates shuffled into the United Nations assembly hall, overflow rooms and livestreams, crucial questions surrounding plastic production limits, toxic chemical regulation, human health concerns, finance, and others remained unanswered with just 48 hours left to the deadline.

When the new text landed, that did not change.

The text assembled by negotiation chair Luis Vayas Valdivieso does not define “plastic” or “plastic pollution” – the fundamental crisis the treaty is supposed to address. It does not include the words chemicals, emissions, climate, fossil fuels, or even single-use plastics.

“This text does not have any demonstrable value to end plastic pollution,” Kenya’s delegation said.

The fundamental debate over the scope of the treaty – whether it would address the full life cycle of plastics from the extraction of fossil fuels to manufacturing and disposal – is sidestepped in the active clauses of the treaty. Even Saudi Arabia, in describing the treaty text as a “milestone,” questioned the total omission of scope in the chair’s text.

“We cannot take this text as the basis of negotiations. Our red lines, and the red lines of the majority of countries represented in this room were not only expunged, they were spat on, and they were burned,” Panama delegate Juan Carlos Monterrey told the chair, who sat next to a visibly and uncharacteristically uncomfortable UNEP chief Inger Andersen, to rousing applause from the room.

“Our goal here is to end plastic pollution. Not simply get to a political arrangement,” Monterrey said. “We need to bring production back, we need to bring mandatory reporting back, we need to bring science and justice back to this text.”

The European Union signalled Tuesday it was ready to make a deal, but ‘not at any cost.’

The new text further omits any mention of youth, impacts on future generations, gender or inequality. Generation Z, the youngest generation that will have to reckon with the legacy of the plastic pollution crisis, now makes up one-third of the global population.

Every active article addressing the health impacts of plastic pollution and the 16,000 chemicals used in their production has also disappeared from the new text. These chemicals have been linked to cancer, infertility, cardiovascular disease and hundreds of thousands of premature deaths annually, according to The Lancet.

“We are extremely disappointed at the Chair’s Text’s blatant disregard for the protection of human health and the environment,” said Jam Lorenzo, deputy executive director of BAN Toxics. “A plastics treaty without strong provisions on chemicals of concern can never be successful.”

Two articles considered essential by civil society, health experts and scientists covering transparency and traceability of chemicals used in plastics and regulating the use of the over 4,200 toxic chemicals – and the thousands for which no public health data is available – are gone.

The new treaty draft confirms another central fear of the health community throughout negotiations: mentions of health are framed as “potential health implications” and “risks,” going against mountains of scientific evidence that show the health impacts of plastic pollution as definite, not theoretical.

“The global public is aware of the issues. They know the risks, and they’re demanding this of their government,” Megan Deeney, a Scientists’ Coalition member from the London School of Hygiene and Tropical Medecine said.  “We can choose to do this now, or we can wait until it’s that much worse and that much harder to come back from.”

The two other mentions of health can be found in the preamble, “noting with concern” the effects of plastic pollution on human health, and “recalling” the UN Declaration of Human Rights’ mention of a “right to a healthy environment.”

“In its current form, the proposed text is not acceptable. It does not meet the minimum that is needed to respond to the challenges before us,” Danish Environment Minister Magnus Heunike said on behalf of the EU. “Only through stronger commitments and more concrete provisions can we ensure the transformative impact that this process was intended to deliver for our citizens and the environment.”

Tap stays on

Plastic production is projected to triple by 2060, according to industry and OECD projections. The new treaty draft sets not limits to that expansion.

The pivotal battleground issue of limiting plastic production has been deleted from the active clauses of the treaty text. It is mentioned once in the preamble, “reaffirming the importance of promoting sustainable production and consumption of plastics.”

No mentions of reducing or limiting production are present in the text.

The solutions offered by the treaty to manage plastic production are a complete victory for major plastic-producing nations and the petrochemical industry, including only product design, waste management, and circular economy approaches as remedies.

Less than 9% of all plastics ever produced have been effectively recycled, according to OECD estimates. Yet even that figure exceeds the recycling rates of nations pushing waste management as the solution: Saudi Arabia recycles just 3-4% of its plastic waste, Russia between 5-12%, and the United States only 5-6%.

Global plastic production is expected to triple by 2060, with the plastics market surpassing $1 trillion annually within the decade. If the plastics industry were a country, it would be the world’s fifth-largest greenhouse gas emitter. At projected growth rates, plastics alone could consume a quarter of the remaining carbon budget needed to meet the Paris Agreement’s 1.5°C target.

“The new chair’s text makes a mockery of a three-year-long consultative process that showed broad support for an ambitious plastics treaty that addresses the full life cycle of plastics, including production,” said David Azoulay, head of delegation for the Center for International Environmental Law.

“It gives in to petrostate and industry demands with weak, voluntary measures that guarantee we continue to produce plastic at increasing levels indefinitely, fail to safeguard human health, endanger the environment, and damn future generations,” he added.

The legally binding nature of the treaty also appears obsolete in the context of the new draft, which turns to voluntary measures at national discretion rather than well-defined commitments to measures on chemicals, pollution or production.

Without binding production limits or chemical regulations, the question of who pays for plastic pollution becomes even more critical. Yet unlike other environmental treaty talks – where financing debates over trillions in climate adaptation funds have dominated recent negotiations – the plastics treaty offers only vague promises.

The treaty proposes establishing a new financial instrument, though no numbers or funding targets are mentioned. Like plastic pollution itself, the burden falls heaviest on countries that did little to cause the crisis. Recent experience from the Loss and Damage Fund to the Cali Fund for Biodiversity indicates this fund – still unnamed – will not be operational for years.

“This treaty all but ensures nothing will change,” Azoulay said. “It will be very difficult to come back from this.”

Written in the shadows

INC Chair Luis Vayas Valdivieso has been roundly criticized by nations and civil society for his handling of the negotiations, the vast majority of which have occured behind closed doors.

The negotiations that led to the new text proposed by the chair are shrouded in secrecy. Informal negotiations and closed-door meetings between nations, the chair and UN Environment Programme representatives dominated the process.

Civil society, including many indigenous peoples, waste pickers and frontline communities, travelled to Geneva from around the world, were effectively shut out of the process altogether. A meeting held by Valdivieso to update observers on Tuesday evening lasted ten minutes – he took no questions.

“Why are we here? Why have we paid so much money? Why are the indigenous people here? I honestly don’t know,” said Arpita Bhagat, GAIA’s Plastics Policy Officer, of the exclusion of civil society, adding that the inclusion of civil society has diminished with every INC.

“We are at a point in civil society where we are thinking about our choices,” she added. “We have left our families for two weeks, some people risking their jobs, and for what?”

Nations did not receive the text ahead of the plenary session, which hampered their ability to provide feedback during the short open-floor debate that was allowed. Valdivieso cited his “commitment to incorporating as many … inputs as possible” as the reason for not delivering the text to all countries.

Due to the opaque nature of the negotiations, it is not clear which countries participated in the final drafting of the new treaty text. What is clear is the universal rejection, even from nations seeking a weak treaty: the United States cited seven “red lines crossed,” while Saudi Arabia opposed multiple clauses.

One thing is certain: on Tuesday, Denmark’s environment minister promised “drama” was ahead. With the outrage over the new draft and 48 hours left to the deadline, that drama is well underway.

Image Credits: UNEP.

Robert F Kennedy Jr (right) after being sworn in as President Donald Trump’s (left) health secretary

The Trump administration’s approach to pesticides could determine whether it continues to enjoy the support of Robert F Kennedy Jr’s Make America Healthy Again (MAHA) movement.

Key MAHA leaders, including the leaders of Moms Across America and Children’s Health Defense, wrote a letter to President Donald Trump on Monday urging him not to support “broad liability shields for pesticides and forever chemicals” – or face a backlash in the mid-term elections.

According to the letter, provisions in the House Interior and Environment Appropriations Bill for 2026 “create broad product liability protections for domestic and foreign pesticide and chemical manufacturers by refusing to fund the critical and necessary scientific safety assessments for product label updates of more than 57,000 synthetic chemicals that are required by law, as a favor to the pesticide lobby”.

The letter urges Trump to ensure “any protections for pesticides are stricken from this Appropriations bill”, warning that “creating broad liability protections for pesticides is a losing issue for your party and your coalition, and may well cost you the House majority in the midterms.”

Kennedy’s HHS doesn’t oversee the regulation of pesticides, which falls to the Environmental Protection Agency (EPA). The EPA has been systematically removing environmental regulation over industries – from pollution controls to pesticide restrictions – since Trump assumed office.

Report delay over pesticides?

Tension over the control of pesticides may well be behind the delay of the MAHA Commission report expected Tuesday from US Health and Human Services Secretary  Robert F Kennedy Jr.

Kennedy had been expected to release part two of his MAHA Commission’s “Make Our Children Healthy Again” report, focusing on the research and strategies needed to address the causes of ill-health in America’s children.

It is the follow-up to part one, released in May, which laid out the commission’s assessment of the drivers of the ill-health of America’s children. 

One of these is children’s exposure to chemicals – including “heavy metals, PFAS [“forever chemicals”], pesticides, and phthalates”, according to the report.

It also highlighted that studies of the pesticide, glyphosate, “have noted a range of possible health effects, ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances”, while experimental animal studies have shown that exposure to another pesticide, atrazine, “can cause endocrine disruption and birth defects”.

The US uses more than one billion pounds of pesticide annually and these linger in the soil and groundwater. A 2021 study  reported that pesticides had been found in 90% of the 442 US streams sampled by federal scientists.

Glyphosate, known by its brandname Roundup, is the most widely used pesticide in the US. After Monsanto genetically modified corn, soy and cotton to tolerate glyphosate in the 1990s, its use increased exponentially as a weeds killer alongside these crops.

Atrazine is the second most common pesticide in the US. Both bind to the soil and have been found in groundwater.

In 2021, the EPA (under the Biden administration) determined that atrazine and glyphosate are each likely to harm more than 1,000 of the nation’s most endangered plants and animals.

The European Union (EU) banned atrazine two decades ago, while the use of glyphosate is restricted in the EU.

HHS said this week that while Kennedy had submitted the MAHA part two report to the White House on Tuesday, its public release will happen “shortly” as it “coordinates the schedules of the President and the various cabinet members who are a part of the Commission,” The Hill reported.

Commission members include EPA director Lee Zeldin and Russell Vought, head of the President’s Office of Management and Budget and the architect of Project2025, the rightwing blueprint for the Trump takeover.

Farmers lobby government

Alarmed by the first MAHA Commission report, farmers’ bodies have asserted that restricting or banning pesticides such as atrazine and glyphosate will push up their costs and reduce yields, Progressive Farmer reports.

Among them are the Food and Agriculture Climate Alliance (FACA), a coalition of interest groups including farmers, ranchers, forest owners and agribusinesses, and the National Corn Growers Association (NCGA).

The White House has held meetings with farmer groups in recent weeks to address their concerns about potential restrictions on pesticides. 

Last month, Nancy Beck, EPA deputy administrator in the Office of Chemical Safety and Pollution Protection, assured a meeting of the American Sugar Alliance that glyphosate would not be restricted.

On Tuesday, the Heritage Foundation – the rightwing think-tank that produced Project2025 – hosted a meeting on the “future of farming” that appeared to be aimed at finding common ground between farmers and MAHA supporters.

Trump adviser and wellness influencer ​​Calley Means urged MAHA supporters to attack “the deep state” rather than Trump and Kennedy.

He also told the meeting that “this is a long-term fight”, which “won’t be won if the soybean farmers and the corn growers are our enemy”, reports Progressive Farmer. 

Trump advisor and wellness influencer Calley Means addresses the Heritage Foundation event.

Environmental rollbacks undermine health

Kennedy built MAHA on support from anti-vaxxers and “wellness” advocates with deep suspicions about traditional medicine, which coalesced over suspicions about the mRNA vaccines used against COVID-19. During the COVID-19 pandemic, this group formed an unlikely alliance with Trump-aligned libertarians opposed to vaccine mandates and lockdowns.

So far, he is delivering in spades to the anti-vaxxers – by firing all members of the Centers for Disease Control and Prevention’s (CDC) vaccine advisory group and replacing them with a group dominated by COVID vaccine sceptics, and cancelling $500 million investments in mRNA vaccine development.

But he is unable to deliver to the wellness groups on pesticides as he isn’t in charge of environmental health, which lies with the EPA.

However, the EPA’s actions are premised on removing restrictions on American businesses rather than keeping Americans healthy.

As previously reported by Health Policy Watch, the EPA is considering lifting restrictions on “white asbestos,” the last type of deadly carcinogen still in use in the US. Asbestos exposure causes mesothelioma, lung cancer, and other fatal diseases that kill 40,000 Americans annually.

In April, Trump issued an executive order exempting 68 coal-fired electricity generating units from complying with curbs on mercury, arsenic and lead emissions for two years.

The EPA has already eliminated requirements for most power plants and heavy industry to monitor greenhouse gas emissions, and pushed back a tax on methane emissions.

In January, the Trump administration dismantled the Clean Air Scientific Advisory Committee (CASAC), which protects the American public health from toxic pollutants, while the Chemical Safety Board (CSB), an independent committee that analyzes industrial chemical accidents and develops safety recommendations, is to receive zero budget this year. 

The Trump administration’s cuts to food and medical support for low-income families will also negatively affect Americans’ health.

It has cut part of the food aid for low-income families, the Supplemental Nutrition Assistance Program (SNAP), and slashed $1 trillion from the medical insurance safety net, Medicaid, over the next decade, which is predicted to cause at least 12 million Americans to lose their health insurance.

‘Policing popsicles’

In a bid to win favour with the wellness industry, Kennedy has pursued the elimination of coloured dyes in food. However, immunologist and microbiologist Dr Andrea Love says that Kennedy’s crusade against the dyes is simply because they are synthetic, not because there is evidence that they are unhealthy.

“MAHA is policing popsicles to distract from their erasure of real public health,” writes Love

“Convincing one company to swap the coloring used in their ice cream for another more expensive and less-tested one is going to have zero impact on the health of our country,” adds Love, who is also executive director of the American Lyme Disease Foundation. 

“You can’t ‘pull yourself up by your bootstraps’ when you have no healthcare, no living wage, no support systems, and you’re handed a $6 box of beet-colored cereal in place of public health.”

 

Image Credits: Facebook.

(L-R) Mothers of four Israeli hostages still held by Hamas in Geneva, Left to right Galia David, Viki Cohen, Silvia Cunio, Meirav Gilboa Dalal. Far left, Daniel Meron, Israeli Ambassador in Geneva.

Despite an uptick in food supplies reaching Gaza this month, critical medical equipment remains barred from entry while deaths from malnutrition continue to mount to 147 casualties as of August 5, said Rick Peeperkorn, the World Health Organization’s representative in the Occupied Palestinian Territories Tuesday at a UN press briefing in Geneva.

On the same day, the mothers of four of the estimated 20 living Israeli hostages still held by Hamas, met with the President of the International Committee of the Red Cross (ICRC) in Geneva, appealing that more be done to secure their sons’ release – after a recently released Hamas video depicted one of starving captives, Evyatar David, digging his own grave in a tunnel. 

Galia David, mother of Evyatar, shows her son before captivity, and from a video released by Hamas in late July.

Speaking at the second UN press briefing, hosted by Israel’s Mission to the UN in Geneva, the hostage mothers also expressed fears that the new large-scale Israeli invasion into Gaza city and other areas still controlled by Hamas could lead to their children’s deaths, diverging from the official government line etched recently by Prime Minister Benjamin Netanyahu. 

“I ask the people in the free world to do everything they can to pressure both sides, Hamas and our government, to sign a deal to release them,” declared Viki Cohen, mother of another 21-year-old hostage Nimrod Cohen, 21, who has been in Hamas captivity since 7 October 2023.  

“When I heard that our government is intent on expanding the war in Gaza, I was, as a mother, afraid because we know that Hamas will command its terrorists to kill the hostages whenever the IDF is getting close to them. So I’m afraid for their lives,” Cohen said.

 “Every day for them, it’s a risk, and also for the soldiers who are there. So the only solution, from my point of view, is to finish this nightmare for both sides. We want this war to end.” 

Malnutrition deaths confirmed by WHO

Six-month-old Salam is screened for malnutrition at an UNRWA clinic in Gaza City. (July 2025)

The 147 Gaza malnutrition deaths, confirmed by the WHO, include 98 adults and 49 children, 39 of which were under 5 years old, Peeperkorn said, speaking by video from Jerusalem.  The WHO confirmed count, which the agency said is confirmed directly from Gaza hospital records, is somewhat lower than the count reported by the Hamas controlled- Gaza Health Ministry, which stood at 212 deaths, as of 9 August. 

Israel has accused Hamas of exaggerating those numbers, saying that most such cases involved children or adults with pre-existing conditions. However, nutrition experts explain that in any hunger crisis or famine, most of those who die typically succumb to pre-existing conditions or infections that a well-fed person can fend off, rather than undernourishment, per se.     

Right now, some 2,500 Gaza children were suffering severe acute malnutrition, requiring specialised treatment, Peeperkorn said.  Meanwhile, cases of meningitis and the infection-linked autoimmune disorder Guillain-Barré Syndrome (GBS), which were identified in July, continue to mount with a total of 452 meningitis cases and 76 suspected GBS cases, identified by WHO and its partners.  The outbreaks have been linked to the collapse of water, sanitation and hygiene (WASH) infrastructure; overcrowding in shelters, malnutrition and compromised immunity.

Complex Israeli entry requirements continue to delay medical supply deliveries 

Thousands of pallets of aid waited just inside Gaza border at end of July; Israel blamed UN, while UN says Israeli obstacle course for permissions to collect the aid hinders delayed deliveries.

Two first line treatments, intravenous immune globulin (IVIG) and plasma exchange (PLEX), are currently out of stock, Peeperkorn said, noting that their delivery “needs to be urgently expedited.”

Complex Israeli entry requirements for medical supplies as well as the “arbitrary” denial of entry for international medical teams is leading to more deaths from preventable causes, Peeperkorn stressed. 

Since 18 March 2025, after the collapse of an eight-week ceasefire, Israeli denial rates for medical supply entries had risen by nearly 50 per cent, with 102 “critical international health professionals”, including surgeons and other specialised medical staff, barred from entry, he said.

WHO medicines and equipement supply warehouse in Deir al Balah was destroyed by Israeli forces in late July. There are now fears that the other main warehouse in Gaza city, could meet a similar fate.

Since June, WHO has been allowed to bring in 80 trucks with medical supplies as the blockade eased somewhat. However, entry processes remained “difficult and ever changing,” he added with the entry of many items, including assistive devices, intensive care unit beds, freezers, cold chain medicines, and anaesthesia machines, denied. 

Recently, some 282 pallets of medical supplies entered Israel via Ben Gurion Airport, but the clearance process so far has been too slow. Multiple crossings needed to be opened to allow the delivery of humanitarian supplies, Peeperkorn concluded.

In preparation for the recently announced Israeli plan to expand military operations in northern and central Gaza, taking over Gaza City, WHO has sought to stock up hospitals and build reserves but has so far been unable to do so, Peeperkorn added. 

Peeperkorn also expressed concerns that WHO’s second main warehouse, in Gaza City, is only 500 meters from a new Israeli army evacuation zone, and could be at risk in fighting now, following the destruction of WHO’s warehouse in Deir al Balah in late July.  

Israel has denied hindering aid deliveries.

Flour spilled by trucks en route from the Kerem Shalom crossing to destinations in Gaza  visible in satellite images.

But on Thursday over 100 international NGOs issued a protest letter, saying that along with obstacles faced by the UN, Israeli authorities are obstructing deliveries by dozens of NGOs that previously provided aid to Gaza – denying over 60 such requests in July alone.

Israeli media, as well, has described in detail the gauntlet of barriers aid organizations face — from a new, and more complicated, NGO registration requirements to the army’s designation of very limited, unstable and unsafe delivery routes from Israel’s Zikim and Kerem Shalom crossing points into Gaza, which facilitates looting along the way.

Hostage mothers express fears of broader Israeli incursion into Gaza 

Meirav Gilboa Dallal, mother of Guy, speaking in Geneva after a meeting of hostage mothers and the ICRC President. (Left) Silvia Cuenio, mother of David and Ariel, also still held by Hamas.

At the Israeli press briefing, the hostage mothers said that they had a “frank” conversation with  ICRC President Mirjana Spoljaric, who listened to their concerns over their sons’ wellbeing, and their appeals to the ICRC to intensify its pressure on Hamas to allow access to the hostages. 

In a statement after the meeting to Health Policy Watch, an ICRC spokesman said: “The suffering of the families of hostages is intolerable. It cannot continue. All remaining hostages must be released immediately and unconditionally. A ceasefire agreement is needed now to save lives and bring an end to this nightmare.”

But the mothers also expressed disbelief over reports that Gazans were dying from malnutrition, following Israel’s two month aid blockade on the enclave from early March to mid-May –  -blaming Hamas for hoarding food from their own population, as well as depriving the hostages. 

That, despite the fact that reports by COGAT, the aid coordination arm of the military, shows that aid covering only about 30% of Gaza caloric needs finally entered the enclave in late May, followed by 60% in June and July each. 

The mothers also said maintained that they wanted Palestinians as well as Israelis to thrive, side by side – but that can’t happen if Hamas re-establishes its control over the 365 square meter enclave.   

“I’m not a politician. I want Gazans to live well, and for us to live well. I want peace and love, in this place, where I want my grandchildren to grow up,” said Meirav Gilboa Dallal, mother of Guy, who was kidnapped together with Evyatar David from the Nova Music festival on 7 October 2023. “But both Hamas and the Palestinian Authority are terrorist organizations, and we can’t let them run Gaza. We need something better – maybe something that other countries, perhaps, can bring to Gaza, to rehabilitate it.” 

No clear end game for Gaza in sight 

Gaza in ruins with a widening circle of displacement and malnutrition, and no end in sight.

Speaking at the briefing, Israel’s Ambassador in Geneva, Daniel Meron, denied that Israel wanted to expel Palestinians from Gaza or resettle the enclave with Israeli Jews once the war is over – despite repeated statements by hard right ministers in Israel’s government expressing exactly that ambition. 

But Meron struggled to offer a post-war vision of how Gaza could be rebuilt on terms acceptable to Palestinians and the international community – even if the hostages were released and Hamas was disarmed – ruling out a role for the internationally-recognized Palestinian Authority. 

“Gaza needs to be demilitarized,” said Meron, “Israel needs to continue to have an overriding security control and a non-Israeli peaceful civil administration should exist inside of Gaza. 

“There is no long term plan for Israel to stay a long time in Gaza,” he maintained. “If there was a magic solution, we would have had that a long time ago, but the situation is very complex. …We can think of different ideas of who’s going to govern Gaza…. There could be international forces with some Arab government countries and some others in Western countries getting together to see what could be the right civil administration. 

“But it’s not going to be Hamas. And he said it’s not going to be the Palestinian Authority.”

–Updated Thursday 14.08.2025 with details of a protest letter on humanitarian aid barriers sent by over 100 NGOs to Israeli authorities.

Image Credits: UNRWA, COGAT , Ha'aretz/Planet Labs PBC, E. Fletcher/Health Policy Watch , OCHA.