Technician at work in South Africa’s mRNA vaccine hub, Afrigen.

The COVID-19 pandemic underscored the risks of over-reliance on global supply chains for essential health products. Disruptions led to severe delays and shortages of vaccines, therapeutics, and diagnostics, with low- and middle-income countries bearing the brunt.

Vaccine inequality starkly highlighted Africa’s vulnerability. Yet this crisis unveiled a unique opportunity for the continent: a chance to revolutionize its vaccine manufacturing sector, crucial for health security and economic empowerment.

Strengthening local manufacturing capabilities ensures timely, equitable access to life-saving products and lays the foundation for a healthier, more self-reliant Africa. Despite representing about 20% of the global population, Africa’s vaccine industry only meets about 0.1% of the worldwide demand.

This significant disparity not only poses a threat to public health but highlights the untapped economic potential in the continent’s vaccine manufacturing sector. The demand for vaccines in Africa is currently estimated at over US$ 1 billion per year, and it’s expected to increase significantly as the continent’s population expands, according to Gavi.

African leaders have no excuse: they must capitalize on these opportunities to advance the continent’s health security.

Opportunity meets regulatory momentum

Several recent developments offer promising opportunities to transform Africa’s vaccine manufacturing landscape.

The operationalization of the African Medicines Agency (AMA), with its Governing Board recently established, is a game-changer for Africa’s pharmaceutical landscape. AMA’s mandate to harmonize regulations, streamline processes, and bolster laboratory capacities is crucial for ensuring locally manufactured health products meet global quality standards. This regulatory support is essential for building trust and ensuring the success of local manufacturing initiatives.

Moreover, the inclusion of the African Union (AU) as a permanent member of the G20 not only demonstrates the advancements made in realizing the objectives of Agenda 2063, which seeks to position Africa as a major global player, but also empowers the African Union to wield substantial influence on matters crucial to Africa. This membership provides a unique platform for advocating and securing support for health initiatives crucial to the continent’s needs.

The AU’s Platform for Harmonized African Health Products Manufacturing (PHAHM) is another significant step forward, as it seeks to create a unified single market to foster demand certainty and promote investment in local production.

To date, 21 of Africa’s 54 countries have signed the African Medicines Agency treaty. Fifteen have ratified it.

The launch of the Africa Vaccine Manufacturing Accelerator (AVMA), meanwhile, is set to significantly accelerate the local manufacturing agenda in Africa. Through the AVMA, Gavi will make up to $1 billion available over ten years to support the sustainable growth of vaccine manufacturing on the continent.

This initiative, launched in June, aims to address the high startup costs and financial risks associated with vaccine production by providing financial incentives to local manufacturers. This support is crucial in light of Africa’s existing challenges, including overburdened health systems, rising national debt, and limited fiscal space.

AVMA aims to accelerate vaccine production on the continent by providing technical support, facilitating technology transfers, and fostering public-private partnerships. This initiative aligns with Gavi’s new strategic plan, unveiled in Paris, which emphasizes building sustainable vaccine manufacturing capacity in LMICs.

These efforts create a robust framework for not only enhancing Africa’s self-reliance in health product manufacturing but also an active member and contributor to the global vaccine ecosystem. Africa has made tremendous progress and manufacturers are already producing antigens.

Challenges remain, but leaders must act

African Union leaders signed an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s first headquarters in the capital, Kigali, in June 2023.

Despite these advancements, several challenges remain.

Technology transfer, capacity building, and supply chain strengthening require sustained effort and investment. The regulatory landscape needs continual enhancement to support local manufacturing and ensure compliance with quality standards. Additionally, there is a need for greater demand for locally manufactured products, achievable through multi-stakeholder partnerships and supportive government policies.

African leaders must therefore step up their efforts to reach the bold goal of producing 60% of vaccines on the continent by 2040. This vision must include end-to-end capabilities, from research and development to fill-and-finish. Policymakers must now commit to several key actions to realize this goal.

First, major government projects must prioritize investments in infrastructure and capacity building to support local vaccine manufacturing. This includes funding for state-of-the-art manufacturing facilities, training programmes for skilled workers, and research and development initiatives to foster innovation in vaccine production.

African leaders must also ensure there is sufficient and predictable demand from African countries for these vaccines. While we appeal to Gavi and other partners to commit to procuring at least 30% of all vaccines produced by the continent for global consumption, it’s imperative to further strengthen national regulatory authorities to ensure ensure vaccines and health products manufactured in Africa meet the global standards of WHO Maturity Level 3 and above.

mRNA hub
Lab technicians work in laboratories in Afrigen, a company in Cape Town that has been selected as the WHO Vaccine Hub, in South Africa, on 11 February 2022.

That’s where regulatory harmonization is crucial. African countries must fully support the African Medicines Agency (AMA) and its full operationalization to help streamline regulatory processes and ensure that locally manufactured vaccines meet global quality standards. This will build trust in Africa-made vaccines and facilitate their distribution across the continent and beyond.

Public-private partnerships are also essential. African governments should incentivize collaborations between local manufacturers, international pharmaceutical companies, and non-governmental organizations. These partnerships can provide the technical expertise, financial investment, and market access necessary to scale up vaccine production.

African leaders must advocate for and implement policies that support local manufacturing, such as reviewing prohibitive tax laws and introducing tax incentives like tax holidays, reduced corporate tax rates, and subsidies for local manufacturers. These incentives would enhance the competitiveness of local producers and attract investment in vaccine manufacturing.

The path to vaccine self-sufficiency in Africa is challenging but attainable. By leveraging recent developments like the AVMA and fostering a supportive environment for local manufacturing, Africa can build a resilient health system capable of meeting its population’s needs. This transformation will not only enhance health security on the continent but also contribute significantly to global health resilience.

Now is the time for African leaders to act decisively and make vaccine manufacturing a reality for the continent.

About the authors

Maureen Awuor Okoth is the Program Manager of Global Health Research, Development and Innovation at Amref Health Africa. 

Caroline Mbindyo is the Program Director of Global Health Research, Development and Innovation at Amref Health Africa. 

Image Credits: Kerry Cullinan, Rwanda Ministry of Health, WHO.

Officials from the WHO and India at the signing ceremony in Geneva, Switzerland.

India will contribute $85 million over a decade to the World Health Organization’s Global Traditional Medicine Center, the WHO announced.

The center, located in the Indian western city of Jamnagar, aims to strengthen the evidence base for traditional medicine and provide data on related policies, practices and public use.

The donation is part of a larger $250 million investment from India to support the center’s work, including funding for its operations, interim premises, and a new building.

“Traditional medicine supported within national health systems can allow us to reach those most often left behind,” WHO Assistant Director-General Dr Bruce Aylward said of the importance of the donation. “Integration of traditional practice and knowledge is critical to achieving health for all.”

The Jamnagar center’s work will focus on traditional medicine research, primary care integration, indigenous knowledge preservation, digital health applications and a biennial global summit.

“India remains committed to supporting WHO in its work to strengthen traditional medicine systems globally for achieving universal health coverage,” said India’s UN ambassador Arindam Bagchi. “Especially through this Global Centre in Jamnagar.”

Traditional Medicine: Ancient Practices Meet Modern Scrutiny

Billions worldwide rely on traditional medicine, with India at the forefront of integrating these practices into its national health system. In 2014, Prime Minister Narendra Modi established the Ministry of Ayush to revitalize the country’s ancient medical wisdom.

Vaidya Rajesh Kotecha, Secretary of the Ayush Ministry, hailed the WHO agreement as “a major milestone” aligned with Modi and WHO Director-General Tedros Adhanom Ghebreyesus’ vision for the traditional medicine centre’s development.

However, this embrace of traditional medicine has ignited fierce pushback from India’s modern medical community. The Indian Medical Association (IMA) led strikes protesting government policy allowing Ayush doctors – practitioners of disciplines like Ayurveda and homeopathy – to perform surgeries, citing fears for the lives of patients. The IMA has also taken legal action against traditional medicine companies for misleading health claims.

The WHO finds itself walking a tightrope, pledging to promote only evidence-based practices while seeking to integrate traditional medicine where scientifically supported. Yet controversy erupted at the first traditional medicine summit in India in 2023, when WHO social media posts appeared to endorse unproven treatments, contradicting its official stance.

Health Policy Watch reported experts questioning WHO’s apparent support for naturopathy, homoeopathy, and osteopathy as “traditional” medicine, warning against “legitimizing harmful pseudoscience.”

The next traditional medicine summit is scheduled for November 2025.

Image Credits: WHO/Lindsay Mackenzie.

Children are vulnerable to climate change due to a range of underlying vulnerabilities, says the UNICEF in its latest report.

Climate change is endangering children’s health at every stage of development, threatening to reverse decades of progress in reducing child mortality worldwide, according to a new UNICEF report.

The U.N. children’s agency’s “Threat to Progress” report released last week consolidates growing evidence of climate change’s effects on children’s health, identifying six major hazards: extreme heat, droughts, wildfires, floods, air pollution and ecosystem changes.

“Climate change is changing children,” UNICEF said. “It is impacting almost every aspect of child health and well-being from pregnancy to adolescence.”

Children are uniquely vulnerable to climate change due to physiological, psychosocial and behavioral factors, as well as their dependence on caregivers, the report found. Their frequent outdoor activities expose them to environmental risks differently than adults.

Extreme weather events are becoming more common, disrupting food supplies and increasing child malnutrition. Children are also susceptible to injuries from climate hazards and mental health issues, including developmental delays and depression.

UNICEF’s Children’s Climate Risk Index reported in 2021 that one billion children are at extremely high risk from climate impacts, threatening their survival and deepening existing inequities.

“We suffer the most,” said Francisco, a 14-year-old UNICEF child advocate in Somalia. “Children have dreams about the future, but they are losing hope because of climate change. It’s absolutely important to consider children’s health when tackling these issues because the climate crisis is also a health crisis.”

Climate change threatens to reverse gains in maternal and new-born health made over decades, according to UNICEF.

Deadly consequences 

This vulnerability has deadly consequences.

Child mortality has fallen sharply in recent decades, from 93 deaths per 1,000 live births in 1990 to 37 in 2022 for children under 5. Despite this progress, UNICEF calls the current rate “unacceptably high,” with an estimated 4.9 million children dying annually.

Now, climate change threatens to reverse these gains.

The report found that 559 million children currently face frequent heat waves, a number expected to surpass 2 billion globally by 2050. Between 2000–2019 approximately 489,000 heat-related deaths occurred every year, according to the World Health Organization (WHO). U.N. Secretary-General Antonio Guterres warns that nearly 25% of children today endure frequent heat waves.

In low-income countries, a 1 C temperature rise causes 16.6 additional infant deaths per 1,000 live births in the first year of life. With global temperatures on track to rise 2.7 C by the century’s end, this could result in millions of additional infant deaths.

Water stress affects 953 million children, impacting health and food availability. In 2019, air pollution contributed to 476,000 infant deaths in their first month of life.

Climate-related displacement is a major concern. Over the past six years, weather-related disasters caused 43.1 million internal displacements of children, averaging about 20,000 daily.

“These issues are not just future threats; they are current realities impacting our children today,” said Dr Helena Clements, child health officer for climate change at the Royal College of Paediatrics. “We can no longer talk about improving child health without also addressing the urgent need to tackle climate change.”

A warming world is intensifying infectious diseases like malaria and dengue. Heat-related illnesses, asthma, and chronic metabolic and cardiovascular diseases are also worsening. Heatwaves and other climate hazards are linked to pregnancy complications, including preterm births, low birth weight and stillbirths.

Without swift action to mitigate climate change and scale up adaptation measures, children will continue to bear the brunt of the crisis, the U.N. children’s agency said.

Children’s vulnerability to climate change varies widely based on circumstances they didn’t choose: wealth, gender, nationality, and health status. Yet all face a crisis they didn’t create, the U.N. children’s agency said.

Children in countries with poor socio-economic conditions are more vulnerable to the impacts of climate change.

“The world is at a crossroads,” UNICEF said. “The true measure of success or failure in addressing climate change lies not solely in temperature metrics, but rather in the tangible reduction of child mortality and morbidity attributable to its impacts.”

The report urges governments to take decisive action on three fronts to stem the crisis. It calls for drastic emissions cuts to meet the Paris Agreement’s 1.5°C target, a goal that’s slipping away as global temperatures climb.

The agency also pushes for robust measures to shield children from climate impacts, including bolstering climate-resilient healthcare and securing access to food and clean water. Above all, UNICEF stresses that child welfare must be at the heart of climate policy.

“It is our responsibility to call for action on areas such as high greenhouse gas emissions and air pollution, food and water supplies, climate-resilient health services, and overall preparedness for our changing climate,” said Clements. “We cannot allow our children to inherit a damaged and unsafe planet.”

Image Credits: UNICEF report ‘A Threat to Progress: Confronting the Effects of Climate Change on Child Health and Wellbeing’ .

Smoke rises over Northern California amid the ongoing Park Fire, set to become the fourth-largest in state history as firefighters brace for a weekend heat wave expected to bring hotter, drier conditions.

New research suggests long-term exposure to wildfire smoke may significantly increase dementia risk, posing a greater threat to brain health than other forms of air pollution.

The study, presented this week at the Alzheimer’s Association International Conference, examined a decade of electronic medical records for 1.2 million older adults in Southern California from 2009 to 2019. Researchers found a 21% higher risk of dementia diagnosis for every microgram per cubic meter increase in fine particulate matter (PM2.5) from wildfire smoke in the air, measured over three years.

By contrast, a three-microgram increase in PM2.5 from other sources like vehicle emissions or industrial pollution raised dementia risk by only 3%. The results, currently under peer review, account for variables including age, sex, race, ethnicity, smoking status, and income.

“There is quite a bit of prior literature that demonstrates an association between exposure to ambient air pollution and dementia, but there’s very limited research on how wildfire PM2.5, specifically, might be associated with dementia,” said Dr Holly Elser, lead author of the study and neurology resident at the University of Pennsylvania.

California’s ongoing Park mega-fire, which has burned 392,480 acres and become the state’s fifth-largest wildfire on record, underscores the study’s urgency. Smoke from this blaze now blankets regions where the study’s subjects live.

A separate study published in the Proceedings of the National Academy of Sciences (PNAS) in February highlighted the growing threat, revealing some parts of California endured nearly 18 months of high wildfire smoke levels over 15 years. Rural and tribal areas suffered the worst exposure, with some regions facing 10 times the average smoke particle levels.

These findings indicate that many Californians may face a 5% to 50% higher dementia risk, with economically disadvantaged communities experiencing the greatest danger.

“As wildfire events become more intense, more frequent, and occur in places outside of the Western US, we felt this was an important, specific source of air pollution to consider as a potential risk factor for dementia,” Elser said. “This is a real problem.”

Why wildfire smoke may be more dangerous

Firefighters respond to the Park mega-fire in Northern California.

PM2.5, the main pollutant in wildfire smoke, consists of airborne liquid and solid droplets smaller than 2.5 micrometres – about 30 times finer than a human hair. These tiny particles can penetrate deep into the lungs, enter the bloodstream, and potentially reach the brain.

Sources of PM2.5 range from coal- and natural gas-fired plants to cars, agriculture, unpaved roads, construction sites, and wildfires. It can take the form of dirt, dust, soot, or smoke.

While researchers are still investigating why wildfire smoke appears more harmful to brain health than other forms of air pollution, several theories have emerged.

Despite sharing the PM2.5 label, particles from wildfires may be more toxic than urban pollution. Their chemical makeup varies widely based on burned materials, unlike the more predictable composition of vehicle or factory emissions.

“There’s a greater concentration of toxic chemicals in wildfire smoke,” said Niki Rubarth, regional director of the Alzheimer’s Association of Northern California. “Wildfires burn everything in their path so that can be anything.”

A 2022 US study of more than 18 million people linked black carbon, a major component of wildfire smoke, to higher dementia risk. Researchers found that each microgram per cubic meter increase in black carbon raised dementia risk by 12%. That same year, a separate study published in Environmental Health Perspectives revealed that even brief exposure to wildfire smoke could impair cognitive functions, including attention.

Another factor is particle size. PM2.5 particles from wildfires are typically smaller than those from urban pollution, potentially allowing for easier penetration into organs and the bloodstream.

The study’s authors emphasize the need for further research to pinpoint which specific components of wildfire smoke might be driving the increased dementia risk.

“I’m really curious to see whether or not we see a similar association with other neurodegenerative processes like Parkinson’s disease or ALS,” Elser added. The link between air pollution and Parkinson’s – a known cause of dementia – is well-established.  

Experts suggest wildfire smoke’s toxicity isn’t the only factor boosting dementia risk; stress and trauma from these events may also significantly impact cognitive decline.

“Exposure to environmental shocks like wildfires can also uncover cognitive changes already underway,” Elser explained. “The stress and depression associated with these events could potentially unmask neurodegenerative processes that were already present.”

Repeated trauma from losing homes and fleeing wildfires has well-documented links to post-traumatic stress disorder, depression and anxiety across California – all conditions that increase a patient’s risk of dementia.

Similar mental health impacts have been observed globally in relation to extreme weather events. Following devastating floods in the Philippine capital of Manila last year, researchers found evidence of worsened anxiety and distress.

“Repeated chronic stress can cause all sorts of physiological changes,” said Vaibhav Narayan, executive vice president at the Davos Alzheimer’s Collaborative. “Stress is a well-known activator of brain health decline and cognitive issues.” 

“It’s not just the physical impact of these stressors,” Narayan added. “It’s also the psychological impact that is detrimental to brain health.”

Growing evidence links air pollution to dementia risk

Map of active global wildfires. / Source: IQAir

The new findings bolster a mounting body of evidence connecting air pollution, particularly high PM2.5 concentrations, to brain health issues.

In its 2024 update released Wednesday, the Lancet Commission on dementia prevention reported that at least nine systematic reviews and meta-analyses since 2019 have established a strong link between air pollution and increased dementia risk.

Studies worldwide demonstrate air quality’s impact on cognitive health. In China, stricter clean air policies slowed cognitive decline in older adults, while another study found 42.4% higher dementia risk in the country’s more polluted northern regions compared to the south.

In 2022, French researchers linked a 12 microgram per cubic meter reduction in PM2.5 levels over 10 years to a 15% lower dementia risk. In the US, meanwhile, older women experiencing larger improvements in air quality over a decade showed lower dementia risk.

High levels of fine particulate matter correlate with increased rates of dementia, mild cognitive impairment, and Alzheimer’s disease in both wealthy and developing nations, the Lancet Commission found. 

Indoor pollution poses additional threats, particularly in developing countries where solid fuels for cooking and heating are associated with higher dementia risk and faster cognitive decline in adults over 45.

While most studies focus on older adults, experts warn that air pollution could affect brain health earlier in life.

“People entering older age now have been exposed to wildfires quite extensively – potentially through their 40s, 50s and 60s,” said Dr Joan Casey, co-author of the wildfire study and a neurologist at the University of Washington. “That might be really important.” 

The Lancet Commission reported growing support for World Health Organization global air quality guidelines, noting, “It is unclear whether any safe concentration of air pollution exists.”

The commission now estimates that addressing “modifiable” risk factors could prevent up to 45% of dementia cases, up from 40% in its 2020 report. These factors include air pollution, less education, hearing loss, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, smoking, obesity, traumatic brain injury and depression.

“The world can’t afford to ignore the 45%,” said Narayan. “That’s the most scalable way to address this issue.”

Wildfires spread globally 

Smoke from wildfires in North Africa in 2023 crossed the Atlantic, affecting air quality in Latin America.

The study’s findings come amid increasing global wildfire activity. Human-caused climate change has increased atmospheric aridity and fuel dryness, leading to longer, more active fire seasons.

The European Union’s Copernicus Climate Change Service identified significant fire seasons across the world in 2023, from Australia to Bolivia, Algeria, Thailand, North America, Russia, and Chile. 

Canada experienced record-breaking wildfire carbon emissions as climate change more than doubled the likelihood of extreme fire weather in Eastern Canada, while Greece battled the largest wildfire in European Union history. Between 1984 and 2020, the annual area burned by wildfires in the western United States surged by over 300%, with some regions seeing a staggering 1,000% increase. 

Globally, the length of the fire season has lengthened by nearly 20% between 1979 and 2013. 

“The biggest thing will be to slow climate change, stop burning fossil fuels and figure out how we’re going to better manage wetlands so we have reduced wildfire exposures,” said Casey. “Of course, that’s quite complicated.”

Wildfire smoke can impact air quality thousands of miles away. In 2023, Canadian wildfire smoke reached Europe and turned New York City skies orange. Smoke from Algerian wildfires made the reverse journey across the Atlantic, reaching Latin America. 

Experts recommend several strategies to reduce exposure to wildfire smoke, including staying indoors on poor air quality days, using high-efficiency air filters, and wearing N95 or KN95 masks when outdoors during smoke events. However, these measures may not be equally accessible to all populations.

“This is a global problem. Wildfire smoke can travel across oceans and impact everybody,” said Narayan. “But like in everything in life, poor people are always disproportionately impacted.”

Women and children wait outside the MSF clinic in Zamzam camp in January 2024, where a malnutrition crisis was causing one child to die every two hours, according to Médicins sans Frontières.

More than half a million people in Sudan’s North Darfur region are now suffering from famine conditions, the Famine Review Committee (FRC) of the UN’s Integrated Food Security Phase Classification (IPC) announced Thursday. 

The escalating violence in Sudan between government troops and the paramilitary Rapid Support Forces, which broke away from the Sudanese Armed Forces in 2023, is at the root of the food crisis. 

Meanwhile, armed conflicts in the Democratic Republic of the Congo (DRC) and in Gaza continue to perpetuate two more of the world’s other most acute hunger and food crises.

In Sudan, the FRC assessed the conditions in the Zamzam refugee camp near El Fasher town, where some 600,000 people have taken refuge, as experiencing famine risks, the worst of the IPC classification levels. 

Famine is declared when at least 20% of an area’s population suffers from extreme lack of food and hunger (IPC level 5), facing actual starvation. Though the IPC analyzed only the Zanzam camp, the food crisis is likely of a similar scope in other regions of North Darfur, said the IPC.

The camp, set in the southwest of the country, has been besieged by the RSF for months, and famine risks will likely remain severe through the end of October 2024, the IPC assessment concluded. 

In Sudan, 26.6 million people, more than half of the population, are food insecure, according to the World Food Programme (WFP) data. Fighting between the country’s army and RSF, said to be backed by Russia’s Wagner Group, continues to impede the operations of aid organisations. Over 10 million Sudanese are internally displaced and 2 million abroad – the largest number in the world, according to a WHO update July 17.

In Khartoum, free kitchens operating there were forced to shut down in mid-July, due to a lack of funding and food supplies.

The RSF, a rebranded name for the Sudanese Janjaweed militia, has been accused of war crimes over the past decade in Darfur, as well as South Kordofan, and Khartoum, according to groups like Human Rights Watch. The violations include burning villages, raping women, unlawful detentions, and repurposing hospitals and churches as military shields. 

In the Darfur region, many people face hunger (IPC 5), the Famine Review Committee assessed after analysing the situation in the refugee camp next to El Fasher (al-Faschir).

DRC has the largest number of people in need of humanitarian aid in the world 

In the neighbouring Democratic Republic of Congo, meanwhile, more than one million children are at risk from acute malnutrition as rising violence perpetrated by armed militias drives up needs among millions of displaced people, the World Health Organization said on July 12.

The DRC currently has the highest number of people in need of humanitarian aid in the entire world, with 25.4 million people affected, Dr Adelheid Marschang, WHO Senior Emergency Officer, said at a UN press briefing in mid-July. 

Despite this, in the DRC “underfunding is indeed severe,” said Dr Adelheid Marschang, WHO Senior Emergency Officer, in a press briefing July 12.

The WHO is aiming for a $30 mln budget “to address the situation till the end of the year,” she said, but could only access about $6 mln on the day of the briefing.

In the eastern DRC provinces of Ituri, North Kivu and South Kivu, where the rebel M-23 militia, reportedly backed by Rwanda, has made significant inroads, 5.4 million people are food insecure, while almost three million children across the country are severely malnourished, according to the World Food Programme. 

With floods having destroyed this season’s crops, the prospects for next year are even more grim. Unless immediate action is taken, over one million children will suffer from acute malnutrition, the WHO warned.

In Gaza, 96% of the population still faces crisis levels of hunger

Gazans struggle to obtain basic supplies of food and water amidst mounting piles of garbage and debris.

In Gaza, where Israel continues its nine-month military campaign to crush the Islamic Hamas organization following Hamas’ deadly 7 October 2023 raids on Israel, WHO officials have warned that one in four people remain at risk of starvation – even if previous forecasts of widespread famine by July did not yet materialize.  

Some 96% of the enclave’s 2 million residents are facing crisis levels of hunger (IPC 5) – according to the World Food Programme. 

Israel’s closure of the Rafah crossing into Gaza in mid-May has paralyzed the flow of health supplies and humanitarian aid from Egypt – forcing exclusive reliance on Israeli aid crossing points.  

Meanwhile, the World Food Programme (WFP) was forced to reduce food rations in Gaza City in May to ensure broader coverage for people who have been newly displaced after new Israeli incursions in the north and south.  

In June, WFP provided more than a million people in Gaza with food assistance, and more than 153,845 individuals in the West Bank received cash-based transfers.

Image Credits: MSF.org, Domenico-de-ga, UNRWA .

Exposure to infected poultry is among the main sources of avian flu infections

As more avian flu cases are detected across the Asia-Pacific region, the Food and Agriculture Organization (FAO) is calling for “regional efforts to combat a rise” of the disease. Over the past year, highly pathogenic avian influenza clades, especially H5N1, have gained ground globally, infecting an increasing number of species, including poultry, dairy cows, and domestic animals.

As of July 31, one single avian flu variant of H5N1 had infected 172 dairy herds and 13 farm workers in the United States  and continues to spread further, raising questions about the country’s ability to curb the transmissions. 

In the Asia-Pacific region, there have been 13 human H5N1 avian flu cases since late 2023, six of which were reported in Cambodia this year. The newly-reported cases point to a trend of more human infections from the virus.  And in the Asian-Pacific, at least one other avian flu variant is circulating along with the H5N1 type, clade 2.3.4.4b, prevalent in the US.  

“All these cases involved direct contact with poultry or wild birds, and so far, no human-to-human transmission has been observed,” confirmed Filip Claes, FAO’s Asia-Pacific Regional Laboratory Coordinator in an email response to Health Policy Watch.

“The primary threat is that HPAI continues to circulate in poultry causing economic losses. Additionally, it provides an opportunity [for the virus] to continuously adapt, and spill over to additional species, including humans,” he added.

He called for building diagnostics capacity and more data sharing, along with strengthening farming biosecurity and biosafety measures.

Avian influenza has even reached the arctic and Antarctic regions, infecting scavenger species, marine mammals, carnivorous domestic pets, and mammals farmed for fur, and dairy cattle. Since last year, there have been human cases in Australia, India, the US, Mexico, Vietnam, China, and Cambodia. 

Of the 886 human infections reported from 2003 to May 2024, more than half were fatal.

Alhough the World Health Organization continues to assess H5N1-related risks to the public as low (and low-to-moderate for farm workers), the emergence of new, more easily transmissible strains “increases the pandemic threat,” warned Kachen Wongsathapornchai, Regional Manager of FAO Emergency Centre for Transboundary Animal Diseases earlier this week. Calling the recent bird flu surge “deeply concerning” the FAO official appealed for “immediate action.”

Insufficient outbreak response

Avian flu H5N1 situation update as of 31 July 2024 – all reports since outbreak began in March.

“Strengthening and integrating surveillance systems is crucial,” Claes said, enumerating measures South-East Asian countries should implement to fight the outbreaks. “Countries should invest in advanced diagnostic infrastructure and training for laboratory personnel,” as well as enhance international and inter-agency collaboration, prepare biosecurity protocols for farms and consider vaccination campaigns.

In the US, where the virus has infected an expanding circle of dairy cattle herds since first reports emerged in March, the country response is insufficient, US experts have long maintained.

There is, for instance, too little data and research that would ensure better understanding of the virus and the ways in which it transmits – not only through the mammary glands during milking, as was previously thought, new research seems to suggest.

Farmers reluctant to have herds and workers tested

Modes of infection with avian flu from poultry – a likely transmission path for some of the human cases

There is not enough testing infrastructure either. And farmers and their employees are reluctant to get themselves or their cattle tested, posing yet another problem in the US where there is no legal framework for mandatory animal tests.  

Similarly, for farm workers, testing and even wearing personal protective equipment is neither compulsory nor popular due to a general mistrust towards the official agencies, fear of lost revenue or, in the case of the workers, lack of a healthcare insurance.

Meanwhile, lax sanitation procedures in large dairy operations are big enablers of virus transmission, allowing cow-to-cow transmission when milking machines are not cleaned between every individual animal.

“Much more extensive follow up, serology studies and close monitoring of ‘mixing vessel animal species’, for instance pigs,” which can more easily incubate and transmit viruses to humans is needed, said Michael Osterholm, director of the University of Minnesota-based Centre for Infectious Disease Research and Policy (CIDRAP), in earlier comments to Health Policy Watch.

Overall, a more coherent plan of response is urgently needed in the Americas as well as Asia, Claes emphasized. In creating a plan, communication about the risk “with all stakeholders, from national governments to grassroots levels, is crucial to develop awareness and community engagement in tackling and controlling avian influenza.” 

Image Credits: Pickpik, USDA, CDC.

Dr Hans Kluge is working on access to cheaper medicines in Europe.

The World Health Organization’s (WHO) vast European region – 53 countries, including the entire European Union, Russia and even Israel – is often excluded from cheaper medicine deals because of member states’ high- and middle-income status.

But one of the flagship programmes of WHO regional director Dr Hans Kluge is the Novel Medicines Platform (NMP), aimed at enabling access to innovative new medicines such as gene therapy for cancer, that are effective but extremely expensive.

Norway was the inspiration for the NMP, Kluge told Health Policy Watch in a recent wide-ranging interview.

Before Kluge was elected regional director in 2021, he visited Norway, one of the richest countries in the region, and discovered that it was anxious about the financial sustainability of its universal health coverage if it were to open the door to these effective but costly medicines.

“Because they have universal health coverage, this means if they allow one medicine on the market, they’re obliged to give it to everyone. And they were concerned about these innovative cancer and diabetes medicines,” said Kluge.

Norway had started an initiative for cheaper novel medicines, and this was transformed into the NSP,  a multi-stakeholder collaboration that has country, pharmaceutical and patient representatives.

“Recently, [3-4 July] for the first time in two years, we had a physical meeting of the NSP where we convened all 53 member states, big pharma, patients and the insurers,” said Kluge.

The upshot of the meeting was the establishment of four time-limited working groups focused on transparency, solidarity, sustainability, and novel antimicrobials, which will conclude their work by December 2025. 

Joint procurement for non-EU countries?

For the first time, countries outside the European Union (EU) may have access to joint procurement for novel medicines, particularly the smaller countries in the region with little buying clout with pharmaceutical companies, said Kluge.

Describing the NSP as a “policy lab”, Kluge hopes it will open the door to access to cheaper medicines in the region – not just novel medicines.

The WHO has also resolved to second a representative to the EU’s Health Emergencies Preparedness and Response Agency (HERA) to assist non-EU members to get better access to medicines.

“We have been telling the EU that they will never be safe without the Western Balkans, countries such as Georgia, Ukraine and Moldova. We have said, ‘Guys, if you are procuring mpox vaccines, H5N1, don’t forget your neighbours’,” said Kluge, who hails from Belgium. 

He points to a recent EU meeting chaired by Germany on the price of multi-drug-resistant tuberculosis drugs, currently costing $15,000 a year.

“I would like to give some a positive example because I’m a born optimist,” added Kluge. “In Poland, through their parliament, they got concessional prices and also registered them for the Ukrainian refugees. So if there’s political will and determination, it is possible.”

Hepatitis medicines are also cheaper because of advocacy, while Sweden is spearheading an initiative on antimicrobial resistance (AMR),  he added.

The ‘magic bullet’ of primary healthcare

Kluge is also urging all member states to move from expensive hospital-based care to integrated primary health care (PHC), including health education.

“I used to say there is no magic bullet, but I have changed my mind. The magic bullet is called primary health care. We need to strengthen primary health care and make it multidisciplinary.”

PHC, involving “task shifting” to nurses and more digital solutions, can help to address “medical deserts” – found everywhere from Ukraine to rural France.

“Cardiovascular disease is the biggest killer in our region, but two-thirds of people with hypertension don’t know they have it. And only a minority of those who know are adherent to treatment,” says Kluge. “This is basic case management that should be decentralised to primary level.”

He adds that Europe controlled mpox by “empowering trusted messengers in the community”. 

However, the lack of agency of such civil society messengers in certain member states concerns Kluge – such as the criminalisation of LGBTQ groups and civil society organisations that can reach “key populations” most vulnerable to HIV.

“In the EU, and in whole or region, we have to hold the fort, even on basic issues like sexuality education in school. There is a call for family values, but the data shows an increase in infertility because of unsafe abortion; because of the rise in sexual infection related to no condom use. All of a sudden, the European region is not doing well on condom use.”

Ukraine and Russia

Both Ukraine and Russia are in Kluge’s region.

“We have about 300 people in Ukraine double the number of people we had before the war,” says Kluge. “They work on what we call three Rs: response, recovery and healthcare reform.”

This ranges from providing trauma kits at the frontline to assisting with mobile services and modernising Ukraine’s healthcare with the focus on PHC.

“Thanks to the cooperation of civil society, Ukraine has one of the best HIV responses in the region,” Kluge notes.

While the WHO still has a country office in Moscow and continues to provide Russia with technical support, the regional committee decided to move the regional office on NCDs from Russia to Copenhagen. 

Concern for LGBTQ communities, attacks on healthcare

“I am concerned about what are called the key populations, LGBT communities,” Kluge says. “We need to stand strong for those people.  I worked for two years in the former [Russian] gulags with  Medecins sans Frontieres in TB control so I know the situation quite well. 

“What happens with HIV patients in Donbas [the Ukraine territory under Russian control] is a bit of a black hole. The international community needs to ensure these people get access to treatment. I strongly believe dialogue is very important.”

Kluge also condemns the attacks on healthcare – “be it in Ukraine or in Gaza, the second war in my region”. 

“This is a major concern. People get used to this. But each time, we should scream heaven and earth. You cannot attack a doctor. We already have a lack of doctor and nurses.  It is completely unacceptable to kill them.”

Kluge, who is the only candidate staning for regional director in the WHO Europe elections, is expected to be re-elected unopposed at the regional conference in October.

The Global Pandemic Preparedness Summit in Brazil was addressed by arounf 80 experts over two days.

As climate change drives disease outbreaks, the world remains ill-prepared for another pandemic – lacking in collaborative surveillance, diagnostic tools and finance, speakers told the Global Pandemic Preparedness Summit (GPPS) in Brazil.

The two-day summit, attended by a global who’s who of pandemic experts, aimed to “reinvigorate the momentum for pandemic preparedness and response” – but it also offered a sober assessment of global shortcomings.

“Over half of pathogens are being amplified by climate change. With the global circulation of pathogens, there is a larger risk for transmission across different continents,” warned Professor Tulio de Oliveira, the South Africa-based scientist who is a key driver of Africa’s pathogen genome surveillance.

One of Prof Tulio de Oliveira’s slides.

Ethiopia is experiencing its biggest dengue outbreak, while Burkina Faso is also dealing with dengue after a four-year break. There’s a new strain of Chikungunya and a new lineage of cholera in Cameroon, he noted.

The increased interaction between animals, humans and the environment – in part caused by the destruction of environments and migration – has increased the mobility of pathogens, De Oliveira told the summit, hosted by Brazil’s Ministry of Health of Brazil, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Oswaldo Cruz Foundation (Fiocruz).

The WHO is responding to 42 graded emergencies, 15 of which are Grade Three emergencies requiring international assistance, said Dr Mike Ryan, the WHO’s Executive Director of Health Emergencies.

“We’re tracking today a further 168 ongoing health emergencies around the world being managed at a national level, and … responding to cholera in 30 countries, mpox, avian influenza, H5N1, dengue and yellow fever, as well as multiple health emergencies related to war and natural disasters.”

“It’s our very connectedness that exposes us. We are the most connected human population in history. We live in mainly densely populated urban areas where we work, move, gather and socialise intensely.”

Prof Tulio de Oliveira, Director of the Centre for Epidemic Response and Innovation in South Africa.

Diagnostic gaps

According to the non-profit organisation FIND, of 21 pathogens with outbreak potential, SARS-CoV-2 is the only pathogen for which there is adequate diagnostic readiness.

FIND launched its Pathogen Diagnostic Readiness Index (PDxRI), a comprehensive tool for evaluating diagnostic preparedness at the summit. 

“Fast, equitably distributed diagnostics are essential to spot & stem an emerging pandemic. FIND have a partnership-driven, five-year roadmap for diagnostic readiness to achieve the 100 Days Mission. But this requires $100 million in seed funding,” said FIND’s Dr Marta Fernandez Suarez.

The 100 Days mission refers to the need to develop vaccines, tests and treatments within 100 days of an outbreak, and enable access to those who need them most to prevent pandemics.

“Infectious diseases can pop up quickly and we need to make sure we are ready to respond quickly and equitably,” said CEPI CEO Dr Richard Hatchett.

“If a new coronavirus were to emerge, there is the potential we could respond in 100 days. But if a new disease were from the Paramyxovirus or Orthopoxvirus family, we’d likely not be ready yet. Importantly, we are moving in the right direction – but to reach the 100 Days Mission we need to advance capabilities with medical countermeasures and globalise access to these technologies. ”

Access gaps

Anban Pillay, South Africa’s Deputy Director-General of Health, noted that his country had been charged a higher price for COVID-19 vaccines than Europe.

“There are huge problems with the conduct of the pharmaceutical industry when it came to access to vaccines,” said Pillay. “They didn’t provide access. They raised the prices. They decided not to give certain countries stock, even though we were paying higher prices than Europe.

“So we need a different global system about where we access vaccines and other countermeasures, a system that’s equitable, that is linked to need.”

“But access supposes that you have something to access,” noted Dr Mona Nemer, the Canadian government’s Chief Scientific Advisor and Chair of the 100 Days Mission Steering Group.

“And clearly, when it comes to diagnostics and therapeutics, and I dare say to vaccines, for the for the all the different viral families that we now have in front of us, we have a long way to go.”

Financial gaps

The Pandemic Fund’s Priya Basu said that the World Bank had been able to mobilize $2 billion in seed capital from 28 contributors to start the fund and seen “tremendous demand, and good quality projects”. 

During the first round of funding last year, projects “really focused on coordination and collaboration across different arms of government – health, finance, agriculture, animal husbandry, livestock, environment, all coming together”

But demand has far outstripped available finances, with the Fund having raised $850 million but received high quality proposals worth $7 billion.

“One of our biggest challenges is really to raise more money to maintain that momentum, because soon we’ll see a lot of disappointed countries if they don’t receive the money. And so that’s why we’ve just launched our investment case, our short term resource mobilization effort, last week,” said Basu.

Political progress at INB

Ambassador Tovar da Silva Nunes

Post-COVID, much of the world’s focus has been on politicians at the World Health Organization (WHO) negotiating a pandemic agreement. 

Brazil’s Ambassador Tovar da Silva Nunes, who is a vice-chairperson of the WHO’s International Negotiating Board (INB), told the summit he was confident that an agreement would be reached before the next World Health Assembly.

Da Silva Nunes and Ambassador Anne-Claire Amprou will be chairing a sub-committee on pathogen access and benefit sharing (PABS), the biggest sticking point in the talks.

“If we are able to solve what we call article 12, the doors are open for us to conclude the agreement in good time,” Nunes told delegates.

He added that there was no longer much disagreement on clauses relating to One Health.

“There was a perception that a One Health approach that is not a complete approach was wrong and it was not leading to equity,” he explained, adding that lack access to clean water, for example, was a factor in the spread of certain diseases.

“Vector-borne diseases are clearly related to [access to water]. So it has to be complete. This is overcome. We have decided to incorporate one health. It’s a major step for global community health, provided that it is done in a very balanced way.”

Ryan noted that the finer details of PABS might take time, but without a broad international “it will be very hard to achieve what this conference is setting out to achieve”.

Global South solidarity

“Global partnerships are key to the 100 Days Mission’s success,” said Brazil’s Minister of Health, Dr Nísia Trindade Lima. 

“Post-COVID, we’ve learned that equitable R&D, investment and access are crucial for public health. We cannot work only within our countries; we must think beyond borders. It’s time for science, technology, and innovation to unite for robust public health policies. We must work together in global health so that it becomes a reality.”

Summitt attendees from the Global South signed the Rio de Janeiro Declaration, which calls for greater collaboration between partners within the Global North and Global South to overcome disparities in access to health tools and countermeasures in low- and middle-income countries. 

The Declaration also urges global health partners to prioritise research and equitable access policies to focus on end-to-end R&D and support the establishment of the Alliance for Regional and Local Production, Innovation and Access, as discussed within Brazil’s G20 Presidency framework.

“It’s time to think and design a different world with a new mindset to build global health systems and strengthen global pandemic preparedness and response, with coordination between the Global South and North,” Professor Mario Moreira, President of Fiocruz, which initiated the declaration.

Around a quarter of young women have experienced abuse in an intimate relationship by the age of 20.

By the time they turn 20 years old, nearly a quarter (24%) of adolescent girls who have been in a relationship will have experienced physical or sexual violence from their intimate partner, according to a report from the World Health Organization (WHO) published Monday found.

Even though the prevalence of violence among teenagers largely parallels that of women overall, minors are more affected because of their economic dependence and the devastating effect it has on their health and life prospects.

“Intimate partner violence is starting alarmingly early for millions of young women around the world,” said Dr Pascale Allotey, Director of WHO’s Sexual and Reproductive Health and Research Department in a press release.

She highlighted the “profound and lasting harms” such experiences have and called for more health focus on prevention and targeted support for girls.

Using  WHO’s Global database on prevalence of violence against women, the report analyzes data over the last two decades from 161 countries on violence against adolescent girls aged 15-19 years old.

The analysis focuses on sexual and physical violence; psychological violence was excluded due to a lack of commonly agreed on comparison measures.

Long-lasting consequences of partner violence 

Health, educational achievement, future relationships, and the lifelong prospects of young people overall are all affected by intimate partner violence. 

Such violence also has direct effects on physical and mental health, heightening the risk of depression and anxiety disorders, but also injuries, unplanned pregnancies, and sexually transmitted infections.

According to the WHO, 42% of women aged 15-49 who experienced intimate partner violence report an injury as its consequence. 

Intimate partner violence also raises the risk of a miscarriage (16% more likely) or a pre-term birth (41% more likely). Victims were also nearly three times as likely to be infected with a sexually transmitted disease, in comparison to other girls and young women.

Power imbalances drive partner violence

The prevalence of intimate partner violence varies depending on region: from as little as 3% of teenage girls experiencing it in Georgia to as much as 49% in Papua New Guinea.

There are considerable regional differences in the prevalence of intimate partner violence, ranging from 47% in Oceania and 40% in Sub-Saharan Africa to 10% and 11% in Central Europe and Central Asia respectively.

It is generally more common in lower-income countries where women have less power than male partners.

A lower proportion of girls enrolled in secondary school, weaker legal property ownership and inheritance rights, and child marriage all conspire to foster conditions of economic dependency and social isolation that increase the risks of abuse in intimate relationships, the research found.

The keys to improving the situation are “ensuring secondary education for all girls, securing gender-equal property rights and ending harmful practices such as child marriage, which are often underpinned by the same inequitable gender norms that perpetuate violence against women and girls,” said the report’s author, Dr Lynnmarie Sardinha.

Education, legal, and economic empowerment

Currently, no country is on track to achieve the target of eliminating violence against women and girls by 2030, as countries pledged to do under Target 5.2.1 of the 2030 Sustainable Development Goals.

The study highlights the urgent need to strengthen early prevention measures and support services made especially for adolescents. Actions to advance women’s and girls’ agency and rights are another important measure.

Effective interventions can include school programmes that educate all students on healthy relationships and violence prevention, but also more general legal protections and economic empowerment.

Image Credits: USAID, WHO.

A Palestinian girl on bus from Gaza to Israel’s Ramon airfield for airlift to the UAE

Updated: The World Health Organization confirmed Tuesday evening that it had evacuated 85 severely ill and wounded Gazans to the United Arab Emirates for advanced treatment via Israel’s Ramon airfield. 

The complex operation occurred as tensions escalated in the region following the deaths of 12 children in a Golan Heights Druze community –  apparently from a missile fired by the Lebanese Shi’ite Hizbullah. 

The carefully planned evacuation had originally been scheduled to take place on Monday, WHO confirmed. Israel’s Prime Minister Benjamin Netanyahu reportedly had delayed the plan after a missile hit on the soccer field of Majdal Shams, a mountain tourist town near the Lebanese border, early Saturday evening, killing a dozen children aged 10-16. Hizbullah denied responsibility for the attack, but western experts and intelligence sources said that evidence points to a rocket from Lebanon. 

Tuesday’s evacuation of some 35 children and 50 adults, along with 63 family members and care-givers, finally took place under a shroud of secrecy, and on a day when tensions between Israel and Hizbullah soared to new heights as Hizbullah fired over 50 more missiles into northern Israel, killing one more person.

In the early evening, Israel’s response for the Majdal Shams attack finally came in the form of a retaliatory strike on a Beirut apartment building, targeting a senior Hizbullah military commander in an area near the milita’s headquarters, and causing dozens of casualties, according to Lebanese reports. 

Hizbullah has been fighting alongside Gaza’s Hamas ever since the deadly 7 October attacks that triggered the current war.  The Druze, meanwhile, are members of an ancient religious minority whose communities dot the border regions of pre-1967 Israel and the Golan Heights, not to mention Lebanon and Syria – implicating them in the wider Israeli-Arab conflict on multiple fronts.

Majdal Shams, in the Golan Heights, is considered occupied Syrian territory by the United Nations, but it was annexed by Israel in 1981, becoming a popular Israeli tourist destination with rich natural resources and archeological history. Since the eruption of the Syrian civil war over a decade ago, an increasing number of Golan Druze, who already had Israeli residency, have also taken on citizenship. 

‘We hope this paves the way for evacuation corridors via all possible routes’

Sick and injured Palestinians board a bus leaving Gaza for an airlift  to medical treatment in the UAE via Israel’s Ramon airfield.

Reports of a plan to begin airlifting hundreds of seriously ill and wounded children out of Gaza to the UAE via Israel’s Ramon airfield in the Negev desert first surfaced in media reports last week, despite WHO’s efforts to keep the mission under tight wraps. 

The airlift scheme came against a background of mounting international criticism of Israel’s seizure of the Rafah border crossing between Gaza and Egypt in early May. That effectively sealed off the only available route for medical evacuees, as well as for Gazans who could afford the hefty visa fees to escape the war. 

“The patients had cancer, injuries, blood diseases, congenital conditions, neurological conditions, cardiac and liver and renal disease,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in an X post, Tuesday evening.

“We hope this paves the way for the establishment of evacuation corridors via all possible routes,” he added.

The WHO team organized and managed the transfer of patients from over half a dozen areas in Gaza to Israel’s Kerem Shalom crossing under “extremely challenging conditions” the organization said, including active conflict in various parts of Gaza. After the original mission was postponed Sunday, some injured and ill patients had to be held at a Médecins Sans Frontières (MSF) field hospital site, pending Tuesday’s final evacuation.

Speaking at a UN press briefing in Geneva on Tuesday, WHO spokesperson Christian Lindmeier said that some 10,000 people, in all, were in need of medical evacuation – as continued waves of conflict-related displacement, malnutrition and interruptions in medical services continue to haunt Gaza’s 2 million Palestinian residents.  

Since October 2023, around 5000 people have been evacuated for treatment outside Gaza during the grinding nine months of war, with over 80% receiving care in Egypt, Qatar and the UAE.

Many Gazans new rounds of displacement as WHO dispatches 1 million polio vaccines

Administering oral polio vaccine – Gaza’s vaccination rates have dropped sharply.

Lindmeier also echoed recent calls by regional health ministers for a cease fire and an ‘enabling environment’ so that a massive polio vaccination campaign could safely take place in the coming days and weeks.

“Otherwise, the vaccines would be sitting as many other trucks are across the border, either on the Rafah side or at the other checkpoints either inside…or outside Gaza,” Lindmeier said.

WHO last Friday said that it was dispatching 1 million polio vaccines to Gaza after evidence of vaccine derived polio virus was found in local sewage sources. 

No actual cases of polio, which can lead to paralysis and even death, have been reported so far in Gaza. But since the beginning of the war on 7 October, 2023, polio immunization rates have dropped by about 10%, WHO and other global health authorities have observed. And that increases the risk that under-vaccinated Gaza children and adults, who are also suffering from a lack of clean water access and widespread malnourishment, could fall ill. 

“Having vaccine-derived polio virus in the sewage very likely means that it’s out there somewhere in people,” Lindmeier said. “So the risk of (it)… spreading further is there and it would be a setback definitely (for global efforts).”

This is not the first time, either, that polio has circulated in sewage in the densely-populated region. In 2022, Israel conducted its own emergency polio vaccination campaign amongst under-vaccinated groups after a 4-year old Jerusalem child fell ill while six others were diagnosed with asymptomatic cases, and the virus was identified in sewage samples, as well. 

Mounting water, sewage and sanitation crisis 

Explosion of a vital water reservoir in Rafah has prompted outrage internationally and within Israel.

Along with that, there is a mounting water, sewage and sanitation crisis in Gaza – exacerbated by the recent Israeli army explosion of a large water reservoir in Rafah. 

Also speaking at the Tuesday UN briefing, James Elder, a spokesperson for the United Nations Children’s Fund (UNICEF), denounced the blowing up of the Rafah water facility last week at Tel  Sultan – calling it an act of  “blatant disregard” for children’s rights. 

The range of water availability in Gaza is currently 2-9 litres per person per day, he pointed out – whereas the humanitarian minimum standard is 15 liters – and that is notwithstanding the sweltering temperatures Gazans are currently facing at the peak of summer – with daytime temperatures averaging highs of 36°.

Israel’s military has not commented publicly on the incident. But military police are  reportedly probing the incident as a suspected violation of international law, which may have also been sanctioned by a local commander, Israeli media reported. 

The incident provoked expressions of outrage within Israel, as well as internationally, after a soldier who participated in the demolition of the reservoir, known as Canada well, posted a video on Instagram, and later on X, celebrating the explosion with a caption stating it was “in honor of the Sabbath” – the Jewish day of rest.   

The reservoir and solar-powered water treatment facility, was developed by Canada’s International Development Agency in the 1990s and supplies a large proportion of the city’s water needs.

Some 20,000 Palestinians remain in the Rafah area, including in the Tel Sultan area, which had not been subject to forced evacuation.  Around 1.4 million displaced Palestinians had been sheltering there before Israelis forces moved into the southern border city in May.

“Somehow people are holding on, but of course we are now in that deathly cycle whereby children are very malnourished, there is immense heat, there is lack of water, there’s a horrendous lack of sanitation and that’s the cycle,” Elder observed. “On top of that, of course, there is a very, very active conflict.”

Image Credits: X/@Dr Tedros, WHO, Global Polio Eradication Initiative, X/Times of Israel.