The 11th meeting on the Intergovernmental Negotiating Body (INB) is currently underway in Geneva.

The latest draft of the World Health Organization’s (WHO) pandemic agreement shifts key decisions to the Conference of the Parties (COP) – a body that will be set up after the World Health Assembly (WHA) has adopted the agreement.

The draft, developed by the WHO Bureau overseeing the Intergovernmental Negotiating Body (INB) talks, was distributed to delegates late on Monday.

Details about how to implement the contentious Pathogen Access and Benefit Sharing (PABS) system (Article 12) – a mechanism to share information and benefits about pathogens with pandemic potential – is one of those kicked down the road.

“The provisions governing the PABS system, including definitions of pathogens with pandemic potential and PABS Materials and Sequence Information, modalities, legal nature, terms and conditions, and operational dimensions, shall be developed and agreed in an instrument in accordance with Chapter III,” according to the draft.

Chapter III deals with institutional arrangements to bring the pandemic agreement into effect, primarily via a COP convened by the WHO “not later than one year after the entry into force of the WHO Pandemic Agreement”. 

The PABS system will also need to be recognised under the Nagoya Protocol, according to the new draft.

‘Lots of blanks’

Provisions for “pandemic prevention and surveillance” (Article 4) have also been kicked down the road to the COP, which will be charged with further developing these, “taking into consideration a One Health approach”.

In the One Health section (Article 5), the onus rests entirely on countries to develop and integrate measures governing animal and human health.

“This new text sets up a pandemic agreement ‘lite’ where there are lots of blanks left to fill in after the agreement,” says Elliot Hannon, Spark Street senior researcher and an observer at the negotiations.

“The Bureau’s new suggested language really shows they’re taking out the most contentious issues, particularly on PABS, and leaving the details to be worked out later. The aim, of course, is to meet their deadline and to produce some kind of agreement on PABS,” he added.

Hannon also pointed out that the language in the new draft had softened from terms like “hereby establish”, to “agree to establish”. 

“Almost all of the changes are designed to not have to deal with the intricacies of PABS right now. The same goes for Articles 4 and 5 on ‘prevention, surveillance’ and ‘One Health’,” he added.

“This is, obviously counter to what many Global South or developing economy countries are interested in and demanding, as they see the PABS system as a key ball game,” said Hannon.

New tech transfer definition

The draft introduces new two definitions:  “The transfer of technology is understood to mean non-coercive transfer and on mutually agreed terms,” according to the new text. 

“This understanding is without prejudice to other measures that parties may take pursuant to their domestic and/or national legislation, provided that such measures are consistent with their relevant international obligations regarding intellectual property,” it adds.

Meanwhile, it defines “know-how” as the “knowledge and skills required to manufacture products”.

“Negotiators are struggling to find compromise language on technology transfer,” noted Knowledge Ecology International director Jamie Love.

“Everyone knows it is important, but there is a lot of industry lobbying that is making it difficult to reach agreement.”

The 11th meeting of the INB ends on Friday. Negotiators have until May 2025 to reach agreement but keep getting stuck on PABS.

European Commission President Ursula von der Leyen announces Olivér Várhelyi as Commissioner for Health and Animal Welfare.

Hungary’s Olivér Várhelyi has been announced as the new European Commissioner for Health, in a portfolio that now includes animal welfare.

He succeeds Cyprus’s Stella Kyriakides, whose portfolio was health and food safety.

Várhelyi has been the European Commissioner for Neighbourhood and Enlargement since 2019, leading efforts to increase membership of the European Union.

“He will be responsible for building a European health union and continuing the work of beating cancer and on preventive health,” said Commission President Ursula Von der Leyen, announcing his appointment as part of her new European Commission College on Tuesday.

However,  before assuming office, all appointees still face questioning by Members of the European Parliament (MEPs), need the  support of two-thirds of the MEPs on their respective committees and the college has to be voted in by the Parliament.

Várhelyi was nominated by right-wing Hungarian Prime Minister Viktor Orbán. He has a legal background and has served in various positions in the Hungarian public administration, including in trade and industry and foreign affairs. 

Prior to becoming a commissioner, he was Hungary’s Ambassador to the EU. Hungary is one of the least democratic EU members, restricting NGOs, media and women’s and LGBTQ rights.

In July 2022, the European Commission referred Hungary to the Court of Justice of the EU for its 2021 amendments to the Child Protection Law “which included unjustified restrictions on LGBT content, with the excuse of protecting children”, according to Human Rights Watch.

In September 2022, the Hungarian Ministry of Health issued a decree making it mandatory for pregnant women seeking abortions to listen to the foetal heartbeat before terminating the pregnancy.

As Commissioner in charge of enlargement, Várhelyi was accused of not paying enough attention to aspirant EU members’ records on democracy and human rights. In particular, he was accused of “pushing” Serbia’s EU membership despite its failure to make progress on key democratic and human rights issues, according to a report by Politico.

His predecessor, Kyriakides, who describes herself as a human rights advocate on X, comes from Cyprus’s Democratic Party, a centre-right Christian democratic political party

Unlike Várhelyi, she has a background in health and worked in her country’s Ministry of Health between 1976 and 2006, as a clinical psychologist in the Department of Child and Adolescent Psychiatry.

She also championed efforts to combat cancer, serving as president of the First Breast Cancer Movement in Cyprus and then president of the European Breast Cancer Coalition, Europa Donna. 

Open plastic trash burning
Burning waste in a rural town in Egypt. 30 metric tonnes of plastic waste are open burned globally each year. Nearly 60% of plastic waste is burned, yet the issue has “not formed a central part” of the current Plastics Treaty negotiations.

Royda Joseph, a 32-year-old mother of three lives in a community next to the PuguKinyamwezi dump in Tanzania. “The dump is on fire every two days,” Royda told the UK NGO TearFund. “Sometimes, when it is on fire, the smoke is so dark and huge that you can’t see the person in front of you or the house next to you. Because of that smoke I get breathing problems and coughing, and eye problems too. The kids also get a lot of breathing problems: they cough a lot.”

In developing cities, from Lagos, to Cairo and New Dheli, air pollution generated by the burning of plastic waste is a daily reality – a 30 metric tonne a year reality according to a new Nature study from researchers at the University of Leeds in the UK. The study found that some 52 metric tons of plastic waste are improperly disposed of every year. And of that, some 57% of that waste is burned openly, launching a slew of toxic chemicals into the air, and disproportionately affecting communities in the Global South. 

The findings have particular meaning for health, which are not well understood. The resulting smoke is a complex mixture of chemicals – including known or suspected carcinogens like bisphenols, phthalates, and dioxins, and a less-understood threat, microplastics. 

The Nature study comes as negotiators gear up for the next round of discussions over an international treaty  on plastic pollution in November in Busan, South Korea. So far, the focus of negotiations has mainly been on the disposal of plastics in landfills and waterways – and not health-harmful air pollution exposures from incineration. 

Model estimated improper waste disposal across 50,000 municipalities worldwide

Graphic description of the sources of air, water and land-based ’emissions’ from unmanaged plastics debris.

Using artificial intelligence to model and estimate plastic waste across 50,000 municipalities worldwide, the researchers identified Sub-Saharan Africa, South Asia, and South-East Asia as “hotspots” for improperly burned or disposed of plastics. India, followed by Nigeria and Indonesia, tops the list as the largest pollution emitter, producing one -fifth of global plastic pollution at 9.3 metric tonnes of plastic waste. China, Russia, Pakistan, Cambodia, and Brazil also ranked as high pollution producers.  Some 1.5 billion of the world’s 8 billion people, mainly in the Global South, live without any waste collection services or with highly inadequate services. 

As a result, low- and middle-income countries in the Global South emit roughly two-thirds of the world’s unmanaged plastic waste, defined as un-contained debris that winds up in open landfills, along fields and roadsides, or in waterways – or conversely as incinerated microplastics. Altogether, uncollected waste in lower-middle income countries accounts for 38% of total global plastics incineration emissions and 51% of plastic debris. 

While in developed countries, plastics incineration occurs in high-temperature, high-tech industrial burning sites, with controlled emissions release, in developing countries most of this unmanaged plastics waste is burned in open pits or piles in neighborhoods and streets of cities, towns and villages, or on their periphery, the study notes.

Burning plastics release microplastics, other hazardous chemicals

Plastic waste sorting
Over 30 metric tonnes of plastic are burned each year, mostly in lower and middle income countries, leaving millions exposed to toxic air pollutants.

The resulting smoke is a complex mixture of chemicals – including known or suspected carcinogens like bisphenols, phthalates, and dioxins, and a less-understood threat, microplastics. 

The health effects can be severe, Gauri Sanjeev Pathak, an Associate Professor at Aarhus University in Denmark, told Health Policy Watch. 

“Such emissions have been tied to cancer, respiratory problems, immunological issues, and birth defects, among a host of other human and planetary health issues,” she said. 

“Both open burning and degradation of plastics entering the environment as unmanaged solid waste can produce microplastics,” added Katrina Smith Korfmacher, Professor of Environmental Medicine at the University of Rochester and co-director of the Lake Ontario MicroPlastics center. “Open burning poses well-known threats to human health,” she said.

One study estimated that humans may inhale up to 22 million particles of micro- and nanoplastics annually. Inhaling these pollutants can cause breathing problems, exacerbate existing respiratory conditions, and contribute to air pollution-related diseases.

Gaps in knowledge about the health effects of plastics air pollution exposures

Despite the growing number of studies on the health risks of microplastics, the World Health Organization (WHO) notes that “many gaps remain in the current scientific knowledge of the health impacts of different types of plastics and added chemicals and their breakdown in the environment,” in a December 2023 report to the WHO Executive Board

Along with the direct exposures to humans from incineration smoke, tiny particles of carcinogenic chemicals like dioxins and furans, eventually settle on cropland and in waterways, where they enter the food chain. Dioxins are potentially lethal persistent organic pollutants that can cause cancer and disrupt thyroid and respiratory systems, according to the United Nations Environmental Programme (UNEP). 

Pollution hotspots – South Asia, Sub-Saharan Africa, South-East Asia

Plastic pollution map
Estimate of plastics ’emissions’ for the year 20202, referring to how much plastic ends up improperly incinerated or dumped on land or in waterways.

Just nine countries account for more than half of mismanaged plastics pollution emissions to the air, land and water, in absolute terms. But some countries with low absolute emissions rank high in per capita terms. For example, China, the world’s fourth largest emitter of plastics pollution has a very low per-capita emission rate, while South Sudan has high per-capita rates but low overall emissions. 

In Latin America and the Caribbean, hotspots for per-capita emissions include municipalities in Paraguay, Belize and Haiti.

The study anticipates that Sub-Saharan Africa will become the world’s largest source of plastic pollution within the next few decades as absolute and per-capita emissions continue to climb. Several megacities stand out as key hotspots, including Lagos, Nigeria; Juba, South Sudan; and Nouakchott, Mauritania.

“Across the continent, there is barely any plastic treatment infrastructure in place,” said a WHO Africa Region article on plastic waste.

Waste scavengers on the front lines of exposures

A woman scavenger looks on as two colleagues burn plastic e-waste to recuperate metal wiring

In lieu of government waste collection, “waste-pickers” in the informal sector generally collect and sort plastics – burning much of it to recuperate valuable metals, including wire and other materials that they can then sell or reuse. 

Globally, nearly 60% of all plastic waste globally is collected by waste scavengers in the informal sector. Over 20 million people around the world earn an income in the informal waste sector, collecting, sorting, and selling materials for recycling or reuse, according to the UN Environmental Programme (UNEP). Around 20% of waste scavengers are women, and an uncounted number are children, a 2021 WHO report estimates. The job is hazardous and exposures to the toxic soup of chemicals, directly and through airborne pathways, can cause respiratory illnesses and skin infections, as well as cancers. In addition, women and children are at risk from adverse reproductive and developmental health effects. 

Advocates for safer conditions urge governments and companies to accept Fair Circulatory Principles so that the human rights of waste pickers and other informal workers are recognized. 

The estimates highlight the huge disparities in how countries are able to grapple with plastic waste.  For much of the Global South, waste mismanagement drives pollution, while the Global North’s robust waste collection and management means that a much smaller fraction of plastic waste ends up in the local environment.

Raising awareness about plastics air pollution exposures – and hopes for consideration in a treaty

Managing plastic waste
With more robust waste management systems, wealthier countries are able to keep plastic waste from contaminating the air, soil, and water, leading the UNEP to advocate for more waste management investment.

The updated estimates of pollution from plastics waste, and particularly from incineration, comes just a few months before the next round of negotiations at the Intergovernmental Negotiating Committee on Plastic Pollution in Busan, South Korea, 25 November-1 December.

The study authors hope negotiators will consider the burden of openly burned plastic, a topic that has “not formed a central part of discussions.”

Pathak stressed that “plastic pollution awareness campaigns or policies that focus only on plastic litter can often lead to increased open plastic burning, as communities and local officials engage in clean-up activities to care for their spaces or to meet waste management goals.

“Given low levels of awareness regarding the harms and the persistence of the toxicants from open burning and a lack of real alternatives to deal with collected wastes, communities often end up burning them. This is why it is crucial that policies and interventions to target plastic pollution, especially global interventions designed in the Global North, take a comprehensive view of the plastic problem and pay attention to local constraints and capacities.”

Korfmacher also echoed the need for research and awareness into “how plastics enter the human body and what effects different sizes, shapes, and types of plastics have on human health.” 

Image Credits: S. Samantaroy, Nature , SweepSmart, Nature/Cottom et al, 2024, WHO,2021.

Bavarian Nordic’s MVA-BN is the first mpox vaccine to get WHO pre-qualification.

Bavarian Nordic’s MVA-BN vaccine, has become the first mpox vaccine to be added to the World Health Organization (WHO) prequalification (PQ) list, enabling its use globally.

The WHO has also recommended that single doses be given in supply-constrained outbreak situations instead of the usual two doses, and “off label” use for children as the vaccine is not yet approved for under-18s.

WHO Prequalification (PQ) and Emergency Use Listing (EUL) are mechanisms used to evaluate quality, safety and efficacy of medical products, such as vaccines, diagnostics and medicines, and product suitability for use in low- and middle-income countries. 

“PQ is based on the review of full set of quality, safety and efficacy data on medical products, including risk management plan and programmatic suitability,” according to a Friday media release from WHO.

“WHO’s assessment for prequalification is based on information submitted by the manufacturer, Bavarian Nordic, and review by the European Medicines Agency, the regulatory agency of record for this vaccine,” the WHO added.

A month ago, WHO Director General  Dr Tedros Adhanom Ghebreyesus declared mpox a public health emergency of international concern (PHEIC) as the outbreak intensified in the Democratic Republic of the Congo (DRC) and neighbouring countries.

Since the global outbreak in 2022, over 120 countries have confirmed more than 103 000 cases. 

This year, there have been 25 237 suspected and confirmed cases and 723 deaths from different outbreaks in 14 African countries (8 September 2024). Morocco reported its first case on Thursday.

‘Off label’ for children

A child infected with mpox: since smallpox vaccinations were discontinued, children may be even more vulnerable.

“This first prequalification of a vaccine against mpox is an important step in our fight against the disease, both in the context of the current outbreaks in Africa, and in future,” said Tedros. 

“We now need urgent scale up in procurement, donations and rollout to ensure equitable access to vaccines where they are needed most, alongside other public health tools, to prevent infections, stop transmission and save lives.”

The MVA-BN vaccine (marketed as Jynneous and Imvamune) is administered in people over the age of 18 as a two-dose injection given four weeks apart. After prior cold storage, the vaccine can be kept at 2–8°C for up to eight weeks.

Although, MVA-BN is not yet registered for use in children, the WHO’s head of Research and Development, Dr Ana-Maria Restrepo, told a recent media briefing that the DRC could use the vaccine “off label” for children, and that there were a number of studies – including clinical studies – that had established its efficacy in children. The majority of mpox cases in DRC are in children.

The WHO also noted that it could be used “off-label” for pregnant and immuno-compromised people “in outbreak settings where the benefits of vaccination outweigh the potential risks”.

WHO has also recommended single-dose use in supply-constrained outbreak situations. Available data shows that a single-dose MVA-BN vaccine given before exposure has an estimated 76% effectiveness whereas the two-dose schedule offers an estimated 82% protection.

Help for national regulators

“The WHO prequalification of the MVA-BN vaccine will help accelerate ongoing procurement of the mpox vaccines by governments and international agencies such as Gavi and Unicef to help communities on the frontlines of the ongoing emergency in Africa and beyond,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. 

“The decision can also help national regulatory authorities to fast-track approvals, ultimately increasing access to quality-assured mpox vaccine products,” he added.

The WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization reviewed all available evidence and recommended the use of MVA-BN vaccine in mpox outbreaks for people “at high risk of exposure”. 

Bavarian Nordic CEO Paul Chaplin said that his company is “highly encouraged” by the PQ, “which is a testament to the strengths of our vaccine and the quality of data we have generated through numerous studies, as well as in real life”. 

Company aims for two million doses in 2024

“Bavarian Nordic has recently filed a submission to the European Medicines Agency to extend the approval to adolescents 12-17 years of age and is also working with partners, including the Coalition for Epidemic Preparedness Innovations (CEPI) to evaluate the safety and efficacy of the vaccine in children 2-12 years of age,” according to a company statement.

“While we continue to work with WHO and other regulatory bodies to expand the approval to include children, who are severely impacted by the mpox outbreak, we are pleased that this approval will help accelerate access to our vaccine for communities across the entire African continent and we applaud the WHO for their swift review and action to make this happen,” added Chaplin.

Bavarian Nordic has undertaken to focus its production efforts on MVA-BN, which will enable it to produce two million doses by the end of the year, and potentially 13 million by the end of 2025, the company reported on Thursday.

Dr Rogerio Gaspar, WHO Director for Regulation and Prequalification, said the global body was “progressing with prequalification and emergency use listing procedures with manufacturers of two other mpox vaccines: LC-16 and ACAM2000. We have also received six expressions of interest for mpox diagnostic products for emergency use listing so far”. 

The LC-16 vaccine, produced by Japan’s KM Biologics, is licensed for use in children.

Image Credits: US Centres for Disease Control .

Around 20,000 delegates took part in the European Respiratory Society (ERS) conference in person and online

Long-term exposure to air pollution and lack of green spaces significantly increases the risk of hospitalization for respiratory conditions, according to new research presented at the European Respiratory Society (ERS) International Congress in Vienna this week.

Researchers from the University of Bergen, Norway, found that even in Northern Europe, where air pollution levels are relatively low, exposure to particulate matter, black carbon, and nitrogen dioxide increased the risk of respiratory hospitalization by 30-45% for each measured increase in these pollutants.

The team analyzed data from 1,644 people across five Northern European countries, using the European Community Respiratory Health Survey. They examined respiratory hospitalizations from 2000 to 2010 and evaluated their connection to long-term exposure to air pollutants and green spaces between 1990 and 2000. 

Researchers considered particulate matter, black carbon, nitrogen dioxide, ozone and “greenness” — a measure of vegetation near homes.

 “Air pollution causes persistent inflammation and oxidative stress in the respiratory system,” explained Shanshan Xu, lead researcher from the University of Bergen. “These harmful processes contribute to the development and exacerbation of chronic respiratory diseases, which can escalate into severe health episodes requiring hospital care.”

While access to green spaces led to a decrease in hospitalizations, researchers found it also increased emergency room visits, primarily among people with hay fever.

“It is also likely that long-term exposure to air pollution could lead to a decreased tolerance or increased sensitivity to these pollutants, explaining why even moderate or low levels might cause severe health effects in certain populations,” Xu said.

Traffic and air pollution

A second study led by researchers at the University of Leicester revealed a strong connection between traffic-related air pollution and the progression from asthma to chronic obstructive pulmonary disease (COPD). The study also found that higher exposure to nitrogen dioxide increases this risk, especially in individuals with a genetic predisposition.

“For every 10 micrograms per cubic meter higher exposure to particulate matter, the risk of developing COPD was 56% higher among asthmatic patients,” said lead author Dr Samuel Cai.

“People with asthma should always be aware of air pollution around them and, if necessary and resources allow, take measures such as wearing masks, use an indoor air purifier and reducing outdoor activities when air pollution is at high levels.”

The findings underscore the critical need for effective clean air initiatives and regulations, according to Professor Zorana J. Andersen, Chair of the ERS Health and Environment Committee.

“Air pollution affects everybody, but most people are very limited in the actions they can take against it to protect their health,” she stated. “It falls to policy-makers to come up with some bold actions to tackle air pollution in our cities.”

The power of laughter and genetics

The ERS Congress, which welcomed nearly 20,000 delegates onsite or online over five days, covered a wide range of respiratory health topics. Notable presentations included studies on genetic risk factors for asthma, the impact of medical clowns on pediatric pneumonia patients, and the effects of fine particulate matter on respiratory immune responses.

Researchers presented a new method for calculating a person’s genetic risk of developing asthma. The study, involving about 12,000 participants, successfully predicted asthma-related conditions, with particularly strong results for childhood-onset asthma.

“Using the power of genetics, we were able to predict asthma and asthma-related outcomes in individuals by generating polygenic risk scores,” Bernard S. Striker, the lead author, explained. “We also showed distinct, genetically driven pathways underlying asthma pathophysiology, which could contribute to personalized treatment approaches and risk mitigation.”

In an unconventional study showcasing the congress’s diverse research, scientists found an unexpected aid for children’s respiratory illnesses: laughter. The research on pediatric pneumonia treatment showed that medical clowns significantly reduced hospital stays for young patients.

Dr Karin Yaacoby-Bianu, a pediatric pulmonologist from the Carmel Medical Center in Israel, reported that children with pneumonia who received twice-daily visits from medical clowns during their first 48 hours of hospitalization had shorter hospital stays – 43.5 hours on average compared to 70 hours.

“Laughter and humor may also have direct physiological benefits by lowering respiratory and heart rates, reducing air trapping, modulating hormones, and enhancing the immune function,” Yaacoby-Bianu said.

The results also showed children supported by clowning required fewer days of intravenous antibiotics. While the study didn’t investigate specific mechanisms, Yaacoby-Bianu suggested that by alleviating stress, medical clowns may indirectly support the body’s natural defense mechanisms, potentially reducing the need for antibiotic interventions.

“We proved that laughter is good for health,” Yaacoby-Bianu told Bloomberg. “Every procedure you try to do with a clown is much easier, much nicer. The child forgets that he is in a hospital.”

The conference also highlighted growing concerns over fine particulate matter (PM2.5) and its impact on respiratory health. A comprehensive review examined how PM2.5 affects the respiratory immune system, suggesting that exposure significantly impairs immune cells’ response to microbial infections, potentially contributing to the development of severe respiratory diseases.

Among the hundreds of presentations in Vienna, other cutting-edge topics included the unique health dangers of wildfire smoke, AI-supported respiratory illness diagnoses and lung disease, and the effect of asthma on miscarriages.

COP29 Presidency is looking to make health a permanent issue at this and future COPs.

Health will be an important focus of the upcoming annual United Nations (UN) climate conference taking place in November in Baku, Azerbaijan, according to the COP29 Presidency and the World Health Organization (WHO).

Like the previous COP, there will be a health day and there is a slew of health-focused initiatives, according to Elmar Mammadov, co-lead of the COP29 Global and Regional Initiatives and Action Agenda Team.

The COP29 Presidency and the UN Food and Agriculture Organization (FAO) have launched the Harmonia 4 climate resilience initiative to empower farmers, villages, and rural communities.

Then there is the ‘Baku Initiative on Human Development for Climate Resilience’, which is a multi-sectoral initiative on health, education, jobs, green skills, and youth.

In addition, the COP29 Presidency is exploring a coalition along the lines of Alliance for Transformative Action on Climate and Health (ATACH) that came out of COP26. ATACH is an informal voluntary network to share information-sharing and for cooperation administered by WHO.

“We would like COP29 Presidency to prioritize health on a permanent basis, to make it a long-term, sustainable topic to all COPs in the future,” Mammadov said. He added that the COP29 Presidency would like to bring together all the Presidencies since COP26, along with the WHO, and form a climate and health coalition.

The announcements were made during a webinar jointly organized by the COP29 Presidency and the WHO.

“It will be a very strong legacy on health, starting with the ATACH in COP26 and making sure that we have, every year, a more impactful presence on climate change and health,” said Dr Maria Neira, WHO’s Director of Environment, Climate Change and Health.

Neira hailed the plans for collaboration between COP29 Presidency and other UN agencies like FAO, apart from the WHO to liaise on various issues that affect health.

Elmar Mammadov, Co-Lead of the COP29 Global and Regional Initiatives and Action Agenda Team.

Integrating health into city planning

It has become increasingly clear that the national governments have been slow to move on climate policies despite public rhetoric. And hence the focus has shifted to local administration as they have shown to be more willing to act.

“One of the key topic is integration of health into city planning,” Mammadov said. There will be several events and round tables that would focus on this topic.

“And one round table will be dedicated to nature, healthy cities and urban agriculture. This round table also will produce communicable call to action, [and] particularly will address urban agriculture, healthy cities and nature, because afforestation, reforestation also is one of the key topic for cities,” Mammadov said.

The Presidency has introduced the ‘Resilient and Healthy Cities’ initiative that will keep a track of the healthiest cities and address urban health issues. The World Heart Federation also began ranking cities based on the response to cardiovascular health this year, along similar lines.

COP29 is looking at health through food security, gender equity and environment, among others.

Focus on making COP29 inclusive

The location, high cost of attendance, visa issues and the allocation of time at COPs has usually meant that many groups are excluded.

“We would like to make COP29 inclusive. We would like to hear all voices, all proposals,” Mammadov said. He added that the goal would be to incorporate health into global initiatives to ensure it is a central theme in climate action.

Meanwhile, the Presidency will encourage multilateral development banks and multilateral climate funds to invest in each of these areas, so they get the required climate finance.

Image Credits: Unsplash.

Dealing with dementia (illustrative)
Most caregivers of people with dementia in low-income countries are female relatives.

NAIROBI – Africa can harness community care, traditional health, exercise and digital tools to treat dementia as its population ages, according to experts on the second day of Nature’s “Future of Dementia in Africa” conference,.

The conference, the first of its kind in Africa, was presented in conjunction with the Davos Alzheimer’s Collaborative and Aga Khan University and ran from 11-12 September in Nairobi.

A key focus of the two-day event was the use of traditional, complementary, and alternative medicine in Africa and how it could be integrated with modern healthcare practices.

Razak Gyasi
Razak Gyasi

Razak Gyasi, an associate research scientist at the African Population and Health Research Centre, pointed out that by 2050, 2.1 billion people worldwide will be over the age of 60, with 80% of them living in Africa.

Ageing populations face numerous challenges, including financial loss, social isolation, and decreased mental and cognitive capacity, including dementia.

But addressing mental health in older adults doesn’t have to rely solely on Western medicine, said Gyasi.  Physical activity, for example, can improve mental health in old age, social inclusion increases a sense of belonging, and good sleep quality benefits brain function.

In his study on Ghanaians’ perceptions of traditional medicine, Gyasi showed that community members already use various alternative methods to support healthcare, from physical activity and social inclusion to massage therapy, herbal remedies, prayer, music, and aromatherapy.

The study focused on how people in the Sekyere South District of Ashanti in Ghana, perceive traditional medicine and its role compared to modern medicine. It explored key factors such as the accessibility of traditional medicine, the conditions it treats, its safety, effectiveness, and how it interacts with modern medical systems.

Gyasi’s research used a descriptive cross-sectional survey, collecting data at a single point from 120 participants: 70 traditional medicine practitioners, 30 healthcare users, and 20 modern practitioners.

Data was gathered through questionnaires, interviews, and observations of practitioners’ work environments in nine communities. Both qualitative (interviews and observations) and quantitative (survey) methods were used for data analysis.

The results show that alternative medicine has been effective in treating numerous medical conditions, including malaria, typhoid fever, arthritis, jaundice, infertility, strokes, broken bones, boils, piles, HIV/AIDS, and mental illness. However, there are risks due to the lack of formalised, coordinated interactions between allopathic and traditional healthcare providers.

Gyasi identified what he called “pull factors” that draw people toward traditional medicine and “push factors” that keep them away from modern healthcare.

People are drawn to alternative medicine because it takes a holistic approach and treats the “entire human system,” Gyasi showed. Traditional methods are also deeply rooted in people’s cultural upbringing. Many people believe in the spiritual connection between health’s physical and mental aspects, which draws people toward alternative care.

As one study participant asked, “How can I be cured with a treatment regimen that I do not understand?”

Allopathic deterrents

There are also deterrents within the mainstream health system. Some participants reported that they felt doctors lacked professionalism or embarrassed them during treatment.

Others cited the stigma associated with visiting “White man’s” practitioners. Additionally, many allopathic therapies have side effects that people are unwilling to endure, even if the treatment is effective. Finally, the cost of care is often prohibitive, making modern treatments inaccessible for many.

“The traditional system of medical practice is embedded in our culture and tradition,” Gyasi said. “If you ask any older African, whether from an urban or rural setting, this is what they grew up with. Trying to separate family traditions from the Western system isn’t right. Cooperation should be encouraged.”

He suggested that Africans should be able to benefit from both systems. For example, they might visit a clinic for a diagnosis but rely on traditional remedies within their communities for treatment.

“All of us need to come together and address these issues holistically,” he said.

Care for the Caregiver

Wambui Karanja
Wambui Karanja raised the burden placed on caregivers.

Another significant aspect is the unique role of caregivers in Africa. Wambui Karanja, a project manager at the Brain and Mind Institute at Aga Khan University, said that almost all those with dementia in low- and middle-income countries (96%) live at home.

This places a heavy burden on caregivers and greatly impacts the global distribution of caregiving time, particularly for women who contribute 71% of the global hours of informal care, with the highest proportion in low-income countries. These caregivers need better tools and support to care for those they look after.

Karanja highlighted the efforts of the Alzheimer’s Dementia Organisation of Kenya, which has been working to build caregiver capacity at all levels and equip them with the skills to provide basic care for people with dementia.

During the COVID-19 pandemic, the organisation partnered with the Alzheimer’s Society of Ireland to offer online support from both peers and professionals. A training program helped caregivers improve their understanding of dementia patients, practice self-care, and enhance communication.

Feedback from the program was overwhelmingly positive. Caregivers expressed relief that they finally had someone to listen to them and provide support, making them feel less isolated. The program also provided better insight into what to expect for those caring for loved ones in the early stages of dementia.

While some other African local organisations offer similar programs, Karanja emphasised that there aren’t enough resources or partnerships to adequately support caregivers, particularly in Kenya. She said more investment and collaboration are needed to provide the necessary assistance.

Digital tools

Edem Adzogenu, vice chair of the Nigeria Digital Health Initiative, discussed how digital tools could support the dementia community in general.

“A low-resource continent like Africa, where the kinds of investments that are required to go into clinical trials, etc., might not be available, early diagnosis and intervention is the smartest strategy,” Adzogenu said.

He explained that in Africa, dementia diagnosis typically begins only after significant memory loss but digital tools have the potential to change this.

As many people have access to smartphones, Adzogenu stressed that promoting digital health is more about education than training. He noted that digital tools can collect basic health information and conduct simple screenings to help identify early signs of dementia.

Even if elderly individuals struggle with the tests, younger caregivers or relatives can assist, he said.

During the COVID-19 pandemic, a digital health wallet was implemented in 22 African countries to ensure care continuity. Kenya was the first country to adopt it.

“With that platform, we can now build many other things on top of it, and we are using it for brain health as well,” Adzogenu said.

He again highlighted the widespread use of digital tools in Africa, particularly in areas like fintech and social media.

“It would be remiss to say the valuable aspect of our existence on this planet, our health, is not taking advantage of digital tools,” he concluded. “The question is … how do we create the frameworks to make it possible in health?”

Image Credits: rawpixel.com, Maayan Hoffman.

Attacks on energy and water also threaten health services as Ukraine approaches its third winter in wartime.

As Russian missiles rain down on hospitals and critical energy infrastructure keeping their lights on, Ukraine’s health system faces what could be its most challenging season yet in its third winter of full-scale war, the World Health Organization’s top European official warned Thursday.

“This will likely be the toughest winter of the three that Ukraine has faced since the war started,” Dr Hans Kluge, WHO’s regional director for Europe, told Health Policy Watch in an interview following a press briefing from Kyiv. “Many partners are scaling up assistance to ensure uninterrupted heating, water, electricity – but who knows what tomorrow will bring.”

Since the war began, nearly 2,000 Russian attacks on Ukrainian health facilities, workers and vehicles have been confirmed, resulting in 171 medical staff and patient deaths and 529 injuries. In the last six weeks alone, WHO verified over 30 attacks on 22 facilities across Ukraine.

On Thursday, shelling killed three ICRC staff members at a planned aid distribution site near the frontline in eastern Donetsk.

Power grid attacks cripple healthcare

Large Russian attacks on frontline Ukrainian regions over the past two weeks have targeted energy grids as well as cities.

Russia’s failure to overrun Ukraine militarily has led to a new strategy: making the country unlivable by targeting schools, hospitals, railways and energy systems. The assault on Ukraine’s energy grid directly affects the health system’s ability to provide care. 

The largest missile barrage since the war began occurred just two weeks ago, damaging key energy infrastructure and leaving nearly 250,000 people without power in the Sumy region alone.

“All the attacks on civilian energy infrastructure have direct impacts on hospitals,” Kluge said, speaking at the conclusion of a weeklong WHO tour of the country’s health services. “If you don’t have fridges to safely store blood, for example, then you don’t have blood transfusions – that has an immediate and drastic impact.”

Vaccine storage is another potentially deadly knock-on effect of power outages. If vaccines cannot be refrigerated, routine vaccinations cannot be conducted, putting patients at risk of easily preventable diseases.

 “If this continues, we may well see an increase in vaccine-preventable diseases,” Kluge said. “This, of course, is very regretful because they can be prevented – that’s the whole point of vaccines.”

Kluge (centre) with Jarno Habicht, WHO Ukraine lead (right)

Despite the attacks, Ukraine’s health system has shown resilience, with 93% of facilities nationwide still operational. WHO and Ukraine’s Health Ministry have installed modular clinics near frontline villages where health facilities were destroyed, with 40 such clinics planned across six regions by year-end.

“We had outreach teams who were going to the other side of minefields, ensuring that civilians get their health care services and were equipped with medicines,” said Jarno Habicht, WHO’s representative in Ukraine, who accompanied Kluge on the tour.

 “Every war disrupts, and it disrupts also the health services that we have in Ukraine,” he added. “Ukraine’s system works, but we also see areas where the services are very difficult to access.” 

Blackouts by Design

Russia has destroyed about 50% of Ukraine’s energy infrastructure and 60% of its power generation capacity since the start of its invasion in 2022. Cornerstones of Ukraine’s power grid – including the Zaporizhzhya nuclear power plant, the Kakhovka hydroelectric dam, and the Dnipro hydroelectric power station – have been destroyed or forced offline.

Ukrainians across the country face at least six hours a day without electricity. Even in the capital, some days offer only 10 hours of power. DTEK, Ukraine’s largest private power provider, is operating at 10% of its pre-war generation capacity. The current national power deficit is approximately 35%. DTEK estimates that come winter, blackouts could reach 20 hours a day. 

The consequences of mounting blackouts for a health system already struggling with current outage levels could be severe. Some regions – like Kherson, Mykolaiv, Sumy and particularly Kharkiv – will likely be more impacted due to the extensive destruction of energy infrastructure.

A joint assessment by the WHO and Ukrainian Ministry of Health in July shared with Health Policy Watch found 13% of hospitals were already experiencing significant power outages. Of the facilities with generators available, 33% were not installed or operational. Overall, 16% of all available generators were offline.

Electrical blackouts have also created a new problem: secure and reliable access to clean water. The governors of Dnipro and Poltava sounded the alarm to the WHO delegation led by Kluge this week. 

“Water systems could be compromised – as water distribution sites depend on uninterrupted power supplies,” Kluge said. “This could lead to increased water and foodborne diseases.”

Accessing and affording primary healthcare

Modular primary healthcare clinic, opened 9 September in the Odessa region, offers one response to shortages.

The war has also dealt a significant blow to the finances of Ukrainians, particularly those forcibly displaced – with knock-on effects on families’ ability to access the health care services they need. 

“One in four households is living below the poverty line,” said Habicht, who also accompanied the delegation. “With less means available and rising prices for medicines and other goods, health needs are increasing while access is becoming more challenging.”

Recent WHO assessments reveal that over 80% of households report problems obtaining needed medicines, with 6% unable to access essential medications. One-third of respondents cited insufficient funds to purchase medicines. Some 8% of households lack access to primary healthcare facilities. 

In health clinics, staffing shortages are another critical issue. “Some people are leaving,” Kluge said, noting the snowball effect of COVID-19 and the war on health workers. “In one instance, a hospital went from 800 staff to only 120. Fatigue, burnout, and anxiety are very prominent among the health workforce.”

Mental health problems escalating

Ukrainian children take refuge in a shelter – frontline children have spent the equivalent of 4-7 months underground.

Mental health problems are escalating, with an estimated 10 million people at risk. Ukraine has responded with a national program, training nearly 100,000 non-specialists online to provide mental health support.

A recent UNICEF survey estimates that children in Ukraine’s front-line areas have spent 3,000 to 5,000 hours — about four to seven months — underground since the war began. Half of children ages 13-15 have trouble sleeping, and three-quarters of those ages 14-34 reported needing emotional or psychological support.

“What struck me very much were the children who lost a leg or an arm. How, if they got modern prosthetics, they bounce back,” Kluge said. “They want to be a champion in the Paralympics – their dreams don’t stop.”

Image Credits: @hans_kluge/Foreign Policy, @pavlentij, X/@hans_kluge, @WHOUkraine, UNICEF.

Mpox vaccines in deep freeze storage in Kinshasa, DRC, awaiting distribution in remote regions.

The Democratic Republic of Congo (DRC) is planning to launch its mpox vaccination campaign in early October, marking a critical step in the fight against the ongoing outbreak across Africa, said Dr Jean Kaseya, Director-General of the African Centres for Disease Control and Protection (Africa CDC), on Thursday. 

Kaseya spoke at a press briefing following last week’s arrival of the first 99,100 doses of Bavarian Nordic’s (MVA-BN) vaccine in DRC, the country at the epicentre of the new mpox outbreak.

The DRC’s immunization efforts are complicated by the ongoing conflict with M-23 rebels in outbreak hotspots like South Kivu Province and its embattled capital city, Goma, in the country’s east.

Meanwhile, UNHCR, the UN Refugee Agency, appealed for $21.4 million to boost health services and critical mpox response for about 10 million refugees and host communities across 35 African countries, where overcrowded shelters and limited access to resources are exacerbating the risk of mpox transmission. 

With nearly 25,000 suspected cases reported in Africa so far this year, including in dozens of communities hosting displaced populations, sustained international cooperation and financial support is more urgent than ever to prevent further spread and strengthen public health systems across the continent, said the UN agency in a special report, released Wednesday.

Outbreak has spread to 20 nations

Spread of mpox cases in Africa, as per Africa CDC’s 12 September briefing.

Twenty of the African Union’s (AU) 55 member states across all five AU regions have reported at least one confirmed mpox case, according to the latest Africa CDC report on 8 September, for a total of 24,873 suspected cases, of which 5,549, were laboratory confirmed.

By Thursday, just four days later, the number had swelled to 26,543 reported cases, with nearly 6,000 laboratory confirmed, Kaseya said at the briefing, illustrating the snowballing nature of the epidemic. There have also been 724 reported deaths, for an estimated 2% fatality rate. Some 63% of those infected are men, while 47% are women, and 41% are children under the age of 15, according to the Africa CDC data.

Testing rates are woefully low

But testing rates, at 52.9% are woefully low, he added, saying, “We cannot rely solely on confirmed cases for decision-making and response.”

Vaccine supply and distribution efforts

Kaseya emphasized Africa CDC’s commitment to supporting the planned DRC October vaccine launch, saying that he would attend and get vaccinated himself to demonstrate the vaccine’s safety to the vaccine-hesistant Congolese and wider African public.

“We are ensuring all logistics are in place, including the training of vaccinators and the movement of vaccines to the provinces,” said Kaseya. He noted that Africa CDC teams will be on the ground at the provincial level to support the vaccination program, ensuring a smooth rollout amidst the complex logistics of such a large-scale campaign.

Mpox vaccines arrive on the tarmac in Kinshasa, DRC

The DRC has received about 265,000 doses of the mpox vaccine, primarily from the European Union through a partnership with Bavarian Nordic. But the vaccines are currently being held in cold storage in the capital city of Kinshasa, and transporting them thousands of kilometres away to conflict-ridden eastern DRC is a huge logistic challenge in a country that is the size of western Europe, DRC officials say. 

“Logistic problem, these are I think the biggest challenge because we have to bring the vaccines from Kinchasa to other parts of the country, where we not only have problems with roads, but with distances that are very, very big,”  Dr Roger Kamba, DRC Health Minister, told the BBC recently, adding that there are also more than seven million internally displaced people do to the ongoing conflict with M-23 militants in eastern DRC, 

“So I think we will start maybe at the beginning of October, in two or three weeks, we will start vaccination.” 

He added that the 265,000 doses received so far are “not enough” in a country of more than 100 million people. “But we think that we will receive more doses from Japan, for example, we think it can give us maybe nearly 3 million doses.”  

Kamba was referring to a reported Japanese pledge of several million doses of its new LC-16 vaccine, which has the advantage of being a one-dose vaccine, also approved for use in children. 

Shortages of syringes and protective gear

Additional MVA-BN vaccine donations also are due to come from the United States, which recently donated 50,000 doses to the DRC, and from other international partners, including France and Germany, Kaseya said at the Africa CDC briefing.

Despite these contributions, Kaseya again highlighted that the continent faces a significant vaccine shortfall, with a total need of 10 million doses to adequately protect populations at risk.

A major challenge in the vaccination effort has been the lack of syringes accompanying vaccine donations. Africa CDC said it is working with UNICEF and regional suppliers to address this gap, ensuring that essential supplies are available when the vaccination campaign begins.

Geographic distribution of reported mpox cases, the Democratic Republic of the Congo, 1 January to 26 May 2024 (7,851 cases). Since then infections rates have accelerated further.

The vaccination campaign will initially focus on high-risk areas identified as hotspots for the outbreak, including South Kivu, in Eastern DRC, and Equateur province, in the north west, Kaseya said. 

Equateur is seeing longer transmission chains of the most deadly Clade 1A variant of mpox, which typically spreads from forest animals to household members through skin-to-skin contact as well as through contact with shared items like towels and bedsheets, and can have a mortality rate as high as 10%. 

South Kivu is seeing a surge in a novel strain Clade 1B mpox variant. Somewhat less lethal, it is also being transmitted through heterosexual sexual contact as well as within households and communities – unlike the original Clade 2 variant that is generally much milder, and spread internationally in 2022 and 2023, mainly among men who have sex with men.

The outbreak in these regions has been particularly severe, with children under the age of five representing a substantial proportion of cases. Kaseya stressed the importance of prioritising these vulnerable groups and ensuring adequate protection through vaccination.

Father of six, seeking shelter at a displacement site near Goma in July, after his wife was killed by a rebel bombing in North Kivu, eastern DRC.

Scaling up genomic surveillance

Africa CDC revealed it is also scaling up genomic sequencing efforts to better understand the virus’s spread and its genetic variations across the continent – where a mix of suspected variants are being reported, but genomic mapping remains limited. He said that the goal is to sequence a minimum of 200 samples from each affected African Union member state.

Current data, however, indicates that Clade 1B is the predominant strain affecting children in the eastern part of the DRC, while the milder Clade 2 is more commonly found in West Africa.

Kaseya underscored the need for  financial support to sustain the vaccination campaigns and broader response efforts. Africa CDC’s mpox continental preparedness and response plan is currently calling for $600 million, to not only address immediate outbreak needs but also to build stronger public health infrastructure, including enhanced laboratory and surveillance capacities.

Combatting mpox among Africa’s displaced populations

UNHCR map reflects the convergence of displaced groups and mpox spread.

As for the UNHCR’s $21.4 million appeal, this aims to bolster health services for some 9.9 million forcibly displaced people and host communities in 35 countries across Africa in countries grappling with the spread of mpox. 

Those, most vulnerable populations, are at the highest risk of contracting the disease due to overcrowding and lack of access to basic hygiene and sanitation, warned Allen Maina, UNHCR’s public health chief. 

“For refugees and displaced communities already facing enormous challenges in accessing healthcare, these conditions place them at higher risk of falling sick and make it harder to protect themselves,” Maina stated in a news release.

Africa hosts over a third of the world’s forcibly displaced people, many of whom reside in countries experiencing mpox transmission. These communities are already contending with protracted conflict, chronic funding shortfalls, and other humanitarian crises, making them particularly susceptible to outbreaks.

UNHCR cautioned that the mpox outbreak could further stretch already overburdened humanitarian resources, disrupting critical services such as food distribution, education, and protection activities.

Maina emphasized the need for sustainable financing to strengthen health systems, water and sanitation facilities, and other services, ensuring resilience against current and future health emergencies.

“We need to support governments and partners in the mpox response to ensure that no one is left behind,” Maina said. “Sustainable financing is crucial to maintaining essential services for the most vulnerable.”

Image Credits: BBC/YouTube, Africa CDC, WHO , © UNHCR/Blaise Sanyila, UNHCR.

Polio campaign gets unmderway in northern Gaza on 10 September, the third phase of the staged outreach.

Over half a million Gazan children have been vaccinated against the deadly polio virus over the past 12 days, WHO said on Thursday, on the final day of a campaign that began 1 September, and which officials said appears to have attained the goal of reaching over 90% of the population of children under 10 years of age – at least in its first phase. 

But the longer-term health challenges faced in the war-torn enclave were underlined by a new WHO report, stating that some 22,500 Gazans who have sustained ”life-changing” injuries in the grinding 11-month Israel-Hamas war, will need long-term rehabilitation services that are unavailable from a shattered health system. 

Brief humanitarian ‘pauses’ against grim background of conflict

Dr Rik Peeperkorn, WHO representative to the Occupied Palestinian Territories (OPT), speaking from Gaza.

The polio vaccine campaign has unrolled in the shadow of new Israeli military evacuation orders and aerial bombings in parts of Gaza where displaced Palestinians were sheltering, along with the Israeli military’s discovery of six dead Israeli hostages in a tunnel under the southern city of Rafah, reportedly shot dead by Hamas shortly before the army’s arrival. 

Even so, brief lulls in fighting due to a series of ‘humanitarian pauses’ agreed to by all sides enabled local medical teams, coordinated by WHO, to conduct the three stage polio immunization drive across the central, southern and northern regions of the 365 square kilometre Palestinian enclave. The campaign, involving hundreds of local medical staff, was planned and launched after the initial discovery of poliovirus in Gaza sewage in July, followed by the confirmation of an active polio case in a 10-month old baby in August. 

The case was traced to a vaccine-derived strain of poliovirus, which is commonly emitted in feces, but can mutate and infect other under-immunized children, particularly in degraded sanitation conditions like those faced in wartime Gaza today.      

“So far in the north we have reached 105,909 children under ten years of age. In the middle area: 195,722 and in the south 250,820,” said Dr Rik Peeperkorn, WHO coordinator for the Occupied Palestinian Territories (OPT), in a WHO press briefing on Thursday. 

“This brings the total number of children vaccinated as of yesterday to 552,451. Numbers for today are still awaited,” he said. 

While the original 90% target involved reaching 640,000 children, that estimate of the under-10 population is being revised downward, in light of actual findings during the campaign, Peeperkorn stated. The same outreach must be repeated in a month’s time to deliver a second polio vaccine dose. 

‘Heartening to see response’

“It has been heartening to see the response to the campaign,” Peeperkorn told reporters at a briefing, broadcast from Gaza. “Everywhere the team has gone, parents are doing all they can to ensure their child does not miss vaccination. Many vaccination sites received more than expected crowds. Special coordinated missions were also conducted to reach children in insecure and hard to reach areas.

“I think that it’s amazing what has happened and what is possible where you have specific humanitarian policies, especially for the children, for the families, for everyone. 

“I don’t want to use that word, but it has even a bit of a ‘festive’ environment. Children came out [to be vaccinated] very well dressed. Many children on the streets …were.so joyful, joyful on the which haven’t been the case for the last 11 months. 

“So if this is possible in polio, why can’t we not translate this for other areas?”

Need to extend the polio ‘bubble’ to other humanitarian response efforts

“We are, and we were, and we are a little bit in a polio bubble,” Peeperkorn continued. 

“But we need to extend that, of course, to all the other humanitarian priorities,” he stressed, adding that food, fuel and medical supply distribution remain extremely difficult, while the area also faces looming winter cold and rain, after the scorching heat of the past summer. 

“We still face all of the same challenges we have for the last 11 months, if you talk about security, about getting the right goods and supplies humanitarian goods into Gaza,distributing those humanitarian goods across Gaza, and a deconfliction mechanism.  A lot of our humanitarian missions are still canceled.

“Over the last three weeks, we probably have nine missions to the North, many of those critically essential fuel missions for hospitals. Only four happened. 

“So if it is possible with polio, why can’t we do that in in a much broader area, and make sure that you establish these proper humanitarian corridors, even in a time of conflict?” 

Rehabilitation needs are huge and entirely unmet

Gaza doctor checks amputated limb of a young man.

Along with the constant interruptions in daily humanitariana relief efforts, the rehabilitation needs for injured Gazans constitute a huge, unmet need, for which almost no health services currently exist.

Without quick access to rehabilitation, many injuries will rapidly become even worse, noted Peeperkorn and other WHO experts at the briefing, citing the examples of spinal injuries that can cause knock-on bladder dysfunction, if not treated in time.

The new WHO report estimates trauma injury rehab needs using data from 8,878 injured patients, who were treated by Emergency Medical Teams (EMTs) between January and May, 2024. Based on that data, it extrapolates that at least one quarter of the esetimated 95,000 Palestinians injured in Gaza since the start of hostilities on 7 October, 2023, are estimated to have “life changing injuries that require rehabilitation services now and for years to come.”

Some 13 455 -17 550 people are estimated to have undergone severe limb injuries, which constitute “the main driver of the need for rehabilitation,” Peeperkorn stated, quoting the report. Many of those injured have more than one injury, the analysis found. The most common injury is to a major extremity,  followed by amputation, burn, spinal cord injury and traumatic brain injury. Between 3105 and 4050 limb amputations have been conducted.

The analysis does not distinguish between injured combatants and non-combatants – a distinction the Hamas-controlled Gaza Ministry of Health also has avoided in its 11 months of reporting on injuries and deaths – the latter now estimated at more than 40,000 lives lost.

The WHO analysis also made no estimate of the distribution of such injuries between men, women and children – despite the detailed breakdown in injury types and needs. Asked why age and gender were not at least considered, a WHO spokesperson cited the “limited availability of data” as noted in the report.

Gaza rehab services decimated

At the same time needs are mounting, Gaza’s pre-war rehab services have been decimated, the report underlines.  The enclave’s only limb reconstruction and rehabilitation center, located in Nasser Medical Complex and supported by WHO, ceased operations in December 2023, due to a lack of supplies and the flight of specialized health workers.  The hospital was further damanged during bitter fighting in February. Additionally:

  • The three pre-existing inpatient rehabilitation units (Al Amal, Sheikh Hammad, Al Wafaa) are not operational.
  • The only 2 prosthetic centres were located in Gaza city. One was damaged, one has been inaccessible throughout the war. Some basic repair services have newly restarted at one and a new service is being established in the South.
  • At least 39 rehabilitation professionals are reported killed. Many others are displaced.

Currently, only 17 of 36 hospitals remain partially functional in Gaza, while primary health care and community-level services are frequently suspended or rendered inaccessible due to insecurity, attacks, and repeated evacuation orders, WHO noted.

“The huge surge in rehabilitation needs occurs in parallel with the ongoing decimation of the health system,” said Peeperkorn. “Patients can’t get the care they need. Acute rehabilitation services are severely disrupted and specialized care for complex injuries is not available, placing patients’ lives at risk. Immediate and long-term support is urgently needed to address the enormous rehabilitation needs.” 

Image Credits: WHO, HPW, WHO.