Some 42,000 Gazans will need prolonged rehabilitation care and support due to war-related trauma injuries and amputations.

Beyond the rehabilitation of bodies, mind and critical Gaza health, housing, water and sanitation infrastructure, both Israelis and Palestinians need to confront the darks side of their respective narratives around the two-year war in Gaza in order to advance a cease-fire and, beyond that, a more durable peace. 

As hopes of a cease-fire between warring Israeli and Hamas forces flicker, a new WHO report estimates that some 42,000 Gazans face life-changing injuries that will require years of sustained support in rehabilitation of injured people, as well as of the enclave’s shattered health services and critical water and sanitation infrastructure – not to mention transport and housing – most of which has now been razed to the ground.  

This, along with the legacy of a Palestinian death toll that has now surpassed 66,000 on on the second anniversary of the war, which began on 7 October 2023, when Hamas gunmen overran two dozen Israeli communities near the Gaza border, 1200 people, mostly civilians, in just one day – unleashing a fury of Israeli weaponry against the tiny Gaza enclave.

And while the initial trauma of 7 October fell on Israel, it is Gaza’s Palestinians that have sustained, by far, the brunt of the war’s bloody toll in the long weeks and months since.  Yet, however disproportionate the burden may be – about 2000 Israelis have now died as a result of the conflict to date – both sides will ultimately have to face the dark side of their own respective narratives around the conflict if any kind of cease fire – and hopefully more durable peace plan – is to advance, some Israeli and Palestinian commentators have observed. 

$10 billion to rebuild shattered health system 

Gazans with serious, long-term rehabilitation needs represent about one-quarter of the 167 376 people injured since the war began, according to the new WHO report.  Over 5000 people have faced amputation. Other severe injuries, include damage to limbs (over  22 000); spinal cord (over 2000); brain (over 1300), and major burns (more than 3300). 

Among the seriously ill and wounded, some 15,600 Gazans, including 3800 children, are still awaiting medical evacuation, said WHO Director Tedros Adhanom Ghebreyesus, speaking at a WHO press conference last Thursday focusing on Gaza at the two-year anniversary milestone.  That’s double the number of patients (7841) that have been evacuated since the war began.

“I call for the frequency of evacuations to increase,” said Tedros. “I call on more countries to open their arms to these patients,” he said.

Shifa Hospital, the largest hospital in Gaza, following an Israeli attack on the facility in April 2024.

WHO has previously estimated that some $3 billion would be needed over just the next 18 months to rebuild Gaza’s shattered health system. Costs could be as high as $10 billion over the next several years. 

“Of course, rehabilitation services are also essential for people with noncommunicable diseases and disability,” Tedros added in his remarks.  “But just when they are needed most, attacks, insecurity and displacement have put them out of reach. The explosions that cause these injuries also destroy the health facilities and services needed to deal with them.”

Over the past two years, WHO has recorded 1719 attacks on health facilities, ambulances or health workers in Gaza and the West Bank, resulting in more than 1000 deaths and 1800 injuries.

Only 14 of Gaza’s 36 hospitals remain partially functional, while less than one-third of pre-conflict rehabilitation services are operating, with several facing imminent closure, said Tedros at the press briefing.  While Israel has repeatedly cited the presence of Hamas gunmen inside, around, and in tunnels under, strategically placed health facilities, as justification for the miliary attacks, the narrative has become ever more muddy over the past year. In incidents such as the April shooting deaths of a busload of medics, Israel had to walk back its original account. In July, there was the deliberate destruction of a major WHO medical supplies warehouse by a series of drones. 

Gaza’s main WHO supply warehouse lies in ruins after overnight air attacks on it by Israeli drones and artillery in late July.

The 9 September Israeli evacuation order to over a million residents of Gaza City and its neighbourhoods, requring them to move south to the Al Mawasi humanitarian zone, has now placed one more field hospital, two ambulance centres, 12 urban hospitals, and 23 primary health care centres, within conflict zones, according to WHO.  

Gaza City alone hosts 46% of all hospitals and field hospitals across the entire Strip, accounting for 36% of inpatient beds and nearly 50% of intensive care unit (ICU) beds. Meanwhile,  54% of essential medicines were at zero stock (as of August 2025), according to WHO, citing Gazan health officials. The most affected services include open-heart and orthopedic surgery where nearly 100% of medicines were out of stock, as well as chemotherapy and blood diseases (72%), primary healthcare (60%), and vaccines (58%).  As of 7 October, 18 out of 24 newborns born prematurely needed to be urgently moved out the Gaza City conflict zone to hospitals elsewhere in Gaza, said UNICEF in a Geneva press briefing Tuesday. WHO managed to moved three premies elsewhere four days ago, while two died tragically before the transfer could be organized. 

Famine, unsanitary living conditions 

Hungry children in Gaza beg for food in May, after Israeli imposed a near total blockade in March on most relief supplies.

Add to that continuing hunger and malnutrition, despite recent spikes in humanitarian aid deliveries, displacement of 90% of the population in unsanitary living conditions, and severe ongoing stress.   

Only on Saturday, two more children were reported to have died due to starvation and malnutrition. As of 11 September, a total of 349 deaths from malnutrition, including 92 children, had been confirmed by WHO since the start of the war, while the Gaza Ministry of health put today’s toll at 459 people, including 154 children.

“Displacement, malnutrition, disease, and the lack of assistive products mean that the true rehabilitation burden in Gaza is far greater than the figures presented here,” said Dr Richard Peeperkorn, WHO Representative in the occupied Palestinian territory in a press release, noting that the rehabilitation needs of people living with noncommunicable diseases were not considered in the findings.   

“Conflict-related injuries also carry a profound mental health toll, as survivors struggle with trauma, loss, and daily survival while psychosocial services remain scarce. Mental health and psychosocial support must be integrated and scaled up alongside rehabilitation,” Peeperkorn added. 

Since mid-September, the massive Israeli assault on Gaza City has added to the misery. So far, some 750,000 Gaza City residents have fled, leading to further crowding, as well as water shortages, in Gaza’s central and southern “humanitarian zones.”  Those remaining, meanwhile, lack access to food sources, as well as hospital services. 

 “The spread of infectious diseases also persists, driven by overcrowding, poor water and sanitation conditions, and malnutrition-related weakened immunity,” noted WHO in a mid-September bulletin. Since May 2025, a total of 1106 suspected meningitis cases have been reported, along with  110 suspected Guillain-Barre Syndrome (GBS) cases and a total of 11 TB cases. Last year, a massive WHO-led polio vaccination campaign conducted amidst humanitarian pauses in fighting managed to head off a major outbreak of the paralytic virus.

Israelis focused on hostages and 7 October legacy 

Israelis rally in support of the cease-fire plan Saturday night in Tel Aviv as the last hope for ending the two year war and rescuing 20 living hostages still in captivity.

Meanwhile, within Israel, the 7 October legacy of random death, sexual violence and Israeli displacement, as well as the fate of the 48 hostages still remaining in Gaza among the initial 251 men, women and children who were taken away on that fateful day, continues to haunt Israelis – and define their outlook on the war.  

Beginning at dawn on 7 October, about 4000 Hamas ‘Nukhba’ fighters in  ATVs, pickup trucks and paragliders overcame the border fence dividing the enclave with Israel in the early morning hours, invading the Nova music festival, packed with young people, and about two dozen other Jewish communities near the border.  Another 2000 Gaza civilians followed in their wake. Following a well-rehearsed plan, Hamas forces moved through the tiny rural communities, shooting, stabbing or kidnapping almost anyone they encountered, and setting fire to homes to smoke out women, children and the elderly huddling in bomb shelters.

Israeli Palestinian citizens were not spared either. Twenty people living and working in the area of the attacks were killed by Hamas forces on 7 October, while others were kidnapped.  Qaid Farhan Al-Qadi,  a Bedouin from southern Israel was rescued by the Israeli army in August 2024 after his guards fled. Another Israeli Palestinian, Sameer Talalka, met a tragic fate after he and two Jewish hostage compatriots escaped Hamas together in December 2023, but were then all shot to death by Israeli forces who mistook them for Hamas fighters.

Some 47 Thai, Nepali, Filipino workers, and one Cambodian student, also were shot, stabbed or in at least one documented case, hacked to death on 7 October. Another 33 Thai, Tanzanian and Nepalese nationals were kidnapped, with 29 released in two previous cease fire deals, in November 2023 and between January and February 2024, and two having perished. One Nepalese citizen, Bipin Joshi, 24, and another Israeli Palestinian, Muhammed Al-Atash, are among the 47 remaining hostages; both are presumed dead.

Along with the Hamas onslaught by land, the militant group also launched dozens of missiles into central Israel that same day. Meanwhile, the Lebanese Shi’ite Hizbullah militia attacked with missile fire from the north. Between October, 2023 and June 2024 Hamas launched some 12,000 missiles and Hizbullah around 8,000 projectiles into Israel. In the weeks following the Hamas 7 October bloodbath and Hizbullah attacks, between 200,000 and 250,000 Israelis in the Gaza periphery and along Israel’s northern border were displaced by the war. A November 2024, cease fire agreement with Hizbullah brought a reprieve to northern communities. At that point Hamas capacity to fire had also been seriously degraded by the massive Israeli ground invasion and Israeli families gradually began returning to their burnt out homes near the Gaza border to rebuild. Even so, about 10,000 people remain displaced as of today.   

For Israelis, sexual violence has been another legacy of the 7 October trauma. In July, a major report by a team of independent Israeli legal experts documented over a dozen cases of rape and sexual mutilation during the  Hamas invasion; among the victims were young women trapped, tortured and killed whilst fleeing the Nova music event. 

Israeli Legal and Gender Advocates Call on UN to Hold Hamas Accountable for Sexual Violence on 7 October

That followed a report by a UN fact-finding mission last year that found “reasonable grounds” to believe that multiple incidents of sexual violence occured during the 7 October onslaught.  There was also “clear and convincing” that hostages held by Hamas in Gaza were subjected to sexual violence, said Pramilla Patten, UN Special Representative of the Secretary General on Sexual Violence and Conflict in a subsequent press release. 

Some 100,000 people demonstrated in Tel Aviv Saturday night in support for the US-brokered cease-fire proposal, with a lineup of former hostages, both tearful and angry, expressing hope that the grudging agreement by Israel and Hamas to the broad outlines of the plan might lead to the release of the final 50 captives, only 20 of whom are believed to still be alive.   

Outside of Israel, however, most of the 7 October events and their immediate aftermath have long been forgotten.

Big anti-Israeli demonstrations abroad have underlined the Jewish state’s growing social and political isolation due to the war, not to mention recent political and economic sanctions and the ongoing proceedings of South Africa’s genocide case against Israel in the International Court of Justice in The Hague.  In a preliminary ruling in January 2024, the ICJ found it “plausible” that Israel had committed acts that violate the Genocide convention. Israel, in turn, has called South Africa’s case “wholly unfounded”.

Public anti-Israel protests reached another crescendo only last week following the Israeli navy’s interception of the Freedom Flotilla to Gaza in the Mediterranean Sea, carrying around 470 international activists, including Swedish climate campaigner Greta Thunberg and French member of parliament Rima Hassan. Most were quickly deported.

Quarter of a million people at pro-Palestinian demonstration in Amsterdam Sunday.

In Jewish communities abroad the demonstrations have stoked growing fear – dovetailing with a steep increase in anti-semitic attacks, including, most recently, last week’s car ramming and stabbing attack by Syrian refugee, Jihad al Shamie, of people leaving a synagogue in Manchester, England over the sacred Yom Kippur Jewish holiday, which left two dead.

Confronting a dark narrative

Woulded boy, sitting next to his sister, cries for his mother in Shifa Hospital, following one of many Israeli attcks on Gaza City that coincided with Prime Minister Netanyahu’s speech to the UN General Assembly.

Ultimately, Israelis, as well as Palestinians, will have to confront the dark sides of their respective narratives to move forward, noted the prominent Israeli journalist Nir Hasson, in a probing commentary on the eve of the 7 October anniversary date, that explored why large parts of the Israeli public had turned their backs on Gaza.

“For Israelis, the sun that rose on October 7 has not yet set. That day continues, and with it, the revenge. The fact that we have since killed nearly 20,000 children changes nothing,” Hasson wrote, describing a series of videos of g children wounded in recent Gaza City bombardments, which were published simultaneous with Israeli Prime Minister Benjamin Netanyahu’s speech to the UN General Assembly on Friday, 26 September. 

“Netanyahu and his failed government are responsible for the two greatest disasters in Israel’s history: the massacre of October 7 and the Israeli response to the massacre of October 7. In the first disaster, about 1,200 people were murdered and killed, women and children were abducted, horrific crimes against humanity were perpetrated. 

“In the second disaster, we killed tens of thousands of civilians, caused the death of captives, inflicted destruction on a whole district, initiated mass starvation and committed countless war crimes and crimes against humanity,” Hasson wrote, adding, “As the truth continues to come to light, and the public internalizes the horror in all its grimness, more and more Israelis will seek to distance themselves from the crimes…. Already today many are refusing to take part in them…

“But these are only the margins of the disaster… The real catastrophe is the actual death of tens of thousands of people – buried under the rubble, shot by soldiers while waiting for food, or dying slowly of hunger in hospitals. The many lives that were cut off, the masses of people who have been maimed, the refugees whose body wanders by day and whose sleep wanders by night. The vast suffering that comes with the mourning, the wounds, the trauma. And the whole cities that have been erased and turned into heaps of ruins and dust.

Palestinian urges public to probe Hamas crimes alongside those of Israel

On the Palestinian side, Ahmed Fouad Al Khatib, a Gazan who has lost at least 20 family members in the war, has also urged Palestinians too look at their side in the conflict, and probe the crimes of Hamas against its own people – alongside those of Israel. 

“Hamas actually wants a famine in Gaza,” wrote Al Khatib, a senior fellow at the Atlantic Council, in The Atlantic in July, shortly before a formal declaration of famine was issued by the UN-backed food security assessment group, IPC. “Hamas has benefited from Israel’s decision to use food as a lever against the terror group, because the catastrophic conditions for civilians have generated an international outcry, which is worsening Israel’s global standing.”

Speaking to CNN over the weekend, Al Khatib said, “I want Israel’s bombardment of Gaza to end and for the suffering of Palestinians to stop. The concern is whether the initial phase of the agreement to stop the war and release the Israeli hostages and Palestinian prisoners can evolve into a durable peace, with Hamas still around… 

“The fear that I have is that Hamas will rein but not rule, a scenario in which it does not disarm, and has influence on who gets to be a part of a transitional phase, that is concerning to me and many Palestinians in Gaza… effectively continuing to hold two million Palestinians as hostages to an armed resistance narrative that has only resulted in war, death, destruction and loss of life.”

He called for the entry of an international stabilization force as the first step of any deal, noting that without that:  ”We could be looking at the spread of militias and a very low intensity civil war, in which Hamas, the clans, this new government, if it ever has any executive force, are vying for control… we could be looking at a scenario where Hamas creates basically areas for themselves and their supporters…they might be willing to give up some of their so-called offensive weapons, but they want to keep small arms and small munitions that actually would allow them to suppress local dissent and to control the population,” he said.

High stakes brinkmanship

As the high-stakes brinkmanship over the details of a plan continues, it’s clear that neither the Hamas leadership or the hard-right Israeli government is really happy.  If, a cease-fire could ultimately remove Hamas from power in Gaza, in Israel it could lead to the eventual collapse of Netanyahu’s hard line government – and even his defeat in the next round of elections, scheduled for 2026.  While Israeli Prime Minister has put on a brave face, it’s clear his agreement came against considerable US pressure – following the misbegotten Israeli attack on Hamas officials in Qatar in September.

In a Truth Social post Sunday night, US President Donald Trump urged the parties, which returned to Cairo for negotiations on Monday, to “MOVE FAST… “TIME IS OF THE ESSENCE OR, MASSIVE BLOODSHED WILL FOLLOW — SOMETHING THAT NOBODY WANTS TO SEE.”

Map of initial Israeli withdrawal lines in the first phase of a Gaza cease-fire as per the US plan.

According to the new map, on the  day after the ceasefire (if it takes effect) the IDF, which now controls about 80% of the 365 square kilometer enclave, will still control about 55% of the Gaza Strip. Israeli forces will continue to hold the perimeter, the Philadelphi Corridor, Rafah, and most of Khan Younis and the northern buffer zone.  

In a second phase of withdrawal, Israel would pull back to 40% of Gaza, and in a third phase, 15% to an interim “security buffer zone.” 

The feasibility of the plan remains full of question marks, including how directly the United States would really try to control Gaza through an interim governance arrangement, and how long would that arrangement really last? When would a transition to full Palestinian control take place, and would that include the internationally-recognized Palestinian Authority, which does not formally get a role in Gaza under the Trump plan right now. 

Even so, both the European Union as well as major Middle East leaders have welcomed the plan as a starting point for ending the bloodshed, disease and hunger of a shattered people – even if the joint statement issued by Qatar, Jordan, the UAE, Indonesia, Pakistan, Türkiye, Saudi Arabia, and Egypt, stressed the plan should lead to a “two state solution under which Gaza is fully integrated with the West Bank in a Palestinian state.”  

And that chorus of support includes WHO.  As Tedros said in his statement last Thursday: “Two years of conflict have brought nothing but death, destruction, disease and despair. The most courageous choose peace, so I call on all parties to this conflict to choose peace, now.”

Image Credits: WHO/EMRO , MSF, WHO , Truth Social , @susanabulhawa/X, m.saed.gaza/Haaretz.

While babies and children are being vaccinated againts malaria, few options exist for pregnant women.

The first pregnant woman infected with malaria has been recruited into a Phase 3 trial in Mali that is evaluating the efficacy and safety of antimalarial drugs during the first trimester of pregnancy.

Pregnant women are more susceptible to malaria as they have reduced immunity, and malaria poses serious risks to both mothers and babies.

Malaria in pregnancy is responsible for 20% of all stillbirths and 11% of all newborn deaths in sub‑Saharan Africa, as well as 10,000 maternal deaths globally each year. It can also cause severe maternal anaemia, miscarriage, stillbirth, preterm delivery and low birthweight. 

Some 12.4 million pregnant women in sub-Saharan Africa were exposed to malaria in in 2023, according to the World Health Organization (WHO), yet treatment options for pregnant women, particularly in the first trimester, are extremely limited.

The SAFIRE consortium aims to address this research gap through this trial, which will also be run in Burkina Faso and Kenya.

“To advance the malaria elimination agenda in a meaningful and sustainable manner, properly tolerated and effective options must be made available to everyone at risk of malaria, including pregnant women,” says Myriam El Gaaloul, SAFIRE co-principal investigator. 

‘More equitable’

“Enrolling the first patient into the SAFIRE trial is a decisive step forward that will help pave the way towards a more just and equitable future in the fight against this disease,” added El Gaaloul, who heads the Malaria in Mothers and Babies (MiMBa) strategy at Medicines for Malaria Venture (MMV).

The trial is recruiting women in the first trimester of pregnancy with a malaria who will be treated with one of the three artemisinin-based combination therapies (ACTs).

The trial aims to compare the safety and efficacy of pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DP), both approved for the general population but not yet in early pregnancy, to artemether-lumefantrine (AL), which is approved By the WHO for use in the first trimester.

The women will receive follow-up care throughout their pregnancy until delivery, while their newborns will be followed for up to six months after birth.

Fill ethical gap

“The SAFIRE trial will, on one hand, fill the ethical gap of excluding pregnant women from clinical trials, and on the other hand, provide the necessary information to increase therapeutic options in the guidelines for the management of malaria in all stages of pregnancy, thus contributing to reducing the unacceptable burden of malaria among pregnant women,” says Prof Kassoum Kayentao of The Université des Sciences, des Techniques et des Technologies de Bamako in Mali, SAFIRE’s co-principal investigator.

Before recruiting the women, the consortium conducted formative research to ensure recruitment strategies and participant materials were culturally appropriate and reflected the realities of local communities. 

“The formative research we conducted as part of community engagement was key in understanding socio-cultural beliefs and barriers that could hinder the recruitment and retention of participants,” said Dr Innocent Valea, SAFIRE co-principal investigator from The Institut de Recherche en Sciences de la Santé Burkina Faso.

“It allows us to leverage facilitators and co-design appropriate messages targeted at pregnant women and communities. Moving forward, we remain committed to maintaining this engagement to foster trust and successful collaboration.”

Image Credits: WHO.

A pregnant woman gets examined by a nurse.

Women who lose 300ml of blood after giving birth should be diagnosed with postpartum haemorrhage (PPH) according to new guidelines published by the World Health Organization (WHO), the International Federation of Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM).

In the past, PPH has only been diagnosed if a woman loses 500ml of blood, but this has often meant that the diagnosis is too late for adequate interventions.

Doctors and midwives are now advised to monitor women closely after birth using a calibrated drape, a simple device that collects and accurately quantifies lost blood.

As soon as PPH is diagnosed, the guidelines recommend the immediate deployment of the MOTIVE bundle. This stands for: Massage of the uterus; Oxytocic drugs to stimulate contractions; Tranexamic acid (TXA) to reduce bleeding; Intravenous fluids; Vaginal and genital tract examination; and Escalation of care if the bleeding persists.

PPH affects millions of women annually and is one of the leading causes of maternal mortality, causing nearly 45,000 deaths. 

Even when not fatal, it can cause lifelong physical and mental health impacts, from major organ damage to hysterectomies, anxiety and trauma.  

“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed. While it is not always predictable, deaths are preventable with the right care,” said Dr Jeremy Farrar, WHO Assistant Director-General. 

“These guidelines are designed to maximise impact where the burden is highest and resources are most limited – helping ensure more women survive childbirth and can return home safely to their families.”

Fast, feasible and effective

Motivation for the change comes from a large study published in The Lancet last week, which analysed 12 datasets involving 312,151 women.

The study found that blood loss of 300ml offered the “preferred sensitivity threshold”, particularly when combined with “any abnormal haemodynamic sign”, such as increased pulse rate or a drop in blood pressure.

In rare cases where bleeding continues, the guidelines also recommend surgery or blood transfusions to safely stabilise the woman.

“Women affected by PPH need care that is fast, feasible, effective and drives progress towards eliminating PPH-related deaths,” said FIGO President Professor Anne-Beatrice Kihara.

The guidelines were launched at the president’s session at FIGO’s world congress in Cape Town, South Africa, on Sunday 5 October, which was also declared as the first World Postpartum Haemorrage Day.

“These guidelines take a proactive approach of readiness, recognition and response. They are designed to ensure real-world impact – empowering health workers to deliver the right care, at the right time, and in a wide range of contexts.”

The guidelines also stress good antenatal and postnatal care to mitigate critical risk factors such as anaemia, which increases the likelihood of PPH and worsens outcomes if it occurs. Recommendations for anaemic mothers include daily oral iron and folate during pregnancy and intravenous iron transfusions when rapid correction is needed, including after PPH, or, if oral therapy fails.

The guidance also discourages routine episiotomies to reduce the likelihood of trauma and severe bleeding after birth.

During the third stage of labour, the guidelines recommend administering medicine to support uterine contraction, particularly oxytocin or carbetocin. 

If intravenous options are not available and the cold chain is unreliable, misoprostol may be used as a last resort.

More evidence and protocols

“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent, ICM’s Chief Midwife. 

“These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than evidence and protocols. We call on governments, health systems, donors, and partners to step up, adopt these recommendations, adopt them quickly, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”

According to a commentary in The Lancet, the new guidelines are “an equity intervention” and they align “the prevention–detection–treatment continuum with enablers (eg, supportive infrastructure)” and also state “what not to do when skills or supplies are scarce”.

“The guidelines recognise where women give birth, who is present, and what commodities are reliably available, and they reduce ambiguity that so often paralyses action in the first minutes of a dire emergency.”

Image Credits: Elizabeth Poll/MMV.

From climate shocks to protracted conflicts and shrinking budgets, today’s “metacrisis” is reshaping the future of child health.

In this recent episode of Global Health Matters, host Garry Aslanyan speaks with Landry Dongmo Tsague, director of the Centre for Primary Health Care at Africa CDC, and Debra Jackson, Takeda Chair in Global Child Health at the London School of Hygiene & Tropical Medicine, about what it will take for children not just to survive, but to thrive.

Both guests note the real gains of the last three decades.

Aslanyan points to under-five mortality falling by over 60% since 1990, while Tsague stresses that “we recorded unprecedented gains over the past two decades,” driven by investments in community-based primary care and immunisation reaching underserved populations. But those advances are fragile.

“Since COVID-19 … there’s now serious concern that these gains will be lost,” Jackson says, citing rising temperatures, conflict and the fact that “as of last year, 2024, we reached or exceeded the 1.5-degree target.”

Conflict zones, from the Sahel to Sudan, put children at immediate risk of malnutrition, disease and interrupted services.

“Without peace, there is no health,” Tsague underscores.

He also flags steep funding declines and outlines emerging solutions endorsed by African leaders: boosting domestic budgets, tapping innovative financing such as levies and diaspora remittances, and mobilising blended finance for primary care infrastructure and local manufacturing.

What works on the ground?

Jackson argues for integrated services and better data: “Information systems are going to be critical if we’re going to address this.”

Community engagement is central; in Zimbabwe, mothers co-created a heat early-warning approach and became local advocates.

Looking ahead, Tsague points to youth as a game-changer: “I can’t be optimistic without highlighting the strength that the continent has in its young people,” including plans for 2 million community health workers by 2030.

Watch the full episode: 

Image Credits: Global Health Matters.

In the latest episode of Trailblazers with Garry, host Dr. Garry Aslanyan sits down with Professor Adalsteinn (Steini) Brown, dean of the Dalla Lana School of Public Health at the University of Toronto.

Together, they explore how public health education must evolve to meet the challenges of a rapidly changing world. From integrating data and evidence into policymaking to designing learning health systems that continuously improve, Brown shares insights from his career spanning academia, government, and industry.

He also reflects on the skills and values the next generation of leaders will need to drive meaningful impact in global health.

Listen to the full episode:

 

Image Credits: "Trailblazers with Garry".

An infant surrounded by malaria bednets. Malaria bed nets are still not accessible enough in Africa’s most endemic countries, leading to the needless deaths of hundreds of thousands of people, mainly children and pregnant women, from the parasitic disease.

The President of the Republic of Botswana and Chair of the African Leaders Malaria Alliance (ALMA), writes about the urgency of mobilising funding to defend the gains and further progress in the fight against malaria. 

Despite decades of progress, we are not on track to defeat malaria in Africa. Without more resolve, innovation, financing, and partnerships, we risk sliding back to the days when malaria killed over a million children each year. 

Malaria remains one of Africa’s leading killers of children. This cannot be our legacy. 

The fight against this disease is threatened by a perfect storm: insufficient funding, extreme weather events linked to climate change expanding mosquito habitats, rising drug and insecticide resistance, and humanitarian crises exposing millions to infection. 

Science has done its part. It has given us the tools: new dual-insecticide mosquito nets, effective medicines, and the world’s first malaria vaccines. Unless we act decisively, malaria will continue to claim lives that should have been saved. 

We know what is needed: strong global commitment, effective financing, and shared responsibility. We must achieve a successful Global Fund replenishment to ensure the effective tools reach everyone who needs them.

The Global Fund replenishment is decisive

People with access to an insecticide-treated mosquito nets In sub-Saharan African countries where the Global Fund invests.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria provides over 60% of all international financing for the fight against malaria.  

Since 2002, the Global Fund has helped cut malaria deaths by nearly a third, distributing hundreds of millions of mosquito nets, treatments, and diagnostic tests. That progress cannot be taken for granted – without a fully funded replenishment, millions of children’s lives hang in the balance. The 2025 replenishment will determine whether we advance or retreat. 

Expert economists calculate that every dollar invested in malaria yields four times that in economic growth. It is also an investment in pandemic preparedness, because the systems strengthened to fight malaria are the same ones that detect and respond to new threats. 

These investments strengthen primary healthcare systems by training community health workers, improving diagnostic capabilities, and enhancing supply chain management. They create a foundation for comprehensive healthcare delivery that extends far beyond malaria treatment.

Strengthening domestic resource mobilisation

Twenty African nations rank among the world’s most dependent on U.S. health aid, with several receiving American assistance that exceeds their own government health spending, leaving the continent acutely vulnerable to potential funding cuts.

Africa’s health financing is entering a new era. We must face the reality that official development assistance for health in Africa has fallen by 70% in just four years. Without decisive action, Africa CDC warns that declining aid and rising debt repayments could cost the continent up to four million additional preventable deaths each year by 2030.  

First, we must strengthen domestic resource mobilisation by allocating an increasing proportion of our national budgets to health. We must also tap into public–private partnerships. It makes economic sense for the private sector to operate in a healthy environment. 

We already have proof of concept through innovative platforms such as national End Malaria Councils and Funds, which bring public and private actors together in coordinated action across 11 countries. To date, they have raised more than $166 million in domestic resource commitments to support national malaria strategies. 

These efforts must now be scaled across the continent. We should embrace innovative financing, for example, through solidarity levies on airline tickets, tobacco, or alcohol; diaspora bonds; and community health insurance. We see how possible this is in Rwanda’s Mutuelles de Santé, which covers over 90% of its population.

Next, we need to expand blended finance. This means using public funds to reduce risk and attract private investment, unlocking billions for health infrastructure, supply chains, and local pharmaceutical production. 

The Global Health Investment Fund has used blended finance to bring private investors into funding new vaccines and treatments. With the African health market projected to reach $259 billion by 2030, these investments can build resilience and sovereignty if governed well.

Leveraging World Bank financing 

The International Development Association (IDA) of the World Bank has long supported health system strengthening, be it training community health workers in Senegal or upgrading surveillance systems and strengthening supply chains. 

These investments make a real difference. When health workers can diagnose and treat malaria in the community, through integrated community case management, it also significantly improves maternal and child health.

The IDA’s Booster Program for Malaria from 2005 to 2010 showed that front-loading investment can rapidly cut malaria cases and strengthen the primary health care system. We urgently need to bring back this approach through a second Malaria Booster Program, aligned with national plans, which would help Africa close financing gaps while strengthening systems for the long term.

Where should UN focus?

Global malaria incidence, which accounts for population changes, ticked up last year, translating to 11 million more cases, most of which occurred in the African continent.

In the short term, we must place our emphasis on securing additional financing. 

The Global Fund replenishment, domestic mobilisation, including through the private sector, and World Bank International Development Association financing are not competing choices. They offer a path to close the funding gap, putting Africa back on track to end malaria, and building health systems strong enough to withstand the next pandemic.

But time is not on our side. Donor retrenchment, rising debt, and climate shocks mean that the cost of inaction grows by the day. 

I urge world leaders gathering in New York to see the fight against malaria for what it is: a measure of how committed we are to safeguarding health and human dignity worldwide.

If we fail to finance the fight, history will judge us harshly. If we succeed, millions of children will live, communities will thrive, and Africa will stand stronger against tomorrow’s threats. The choice is ours.

Duma Gideon Boko is the President of the Republic of Botswana and Chair of the African Leaders Malaria Alliance (ALMA). 

Image Credits: Peter Mgongo, Arne Hoel/World Bank.

EHFG President Clemens Marten Auer warned Europe’s health systems face an existential threat from artificial intelligence.

BAD HOFGASTEIN, Austria — Artificial intelligence poses an “existential” threat to Europe’s health and social security systems through its potential to “completely replace” human work and eliminate the income tax funding base on which they depend, a leading health policy figure has warned.

Clemens Marten Auer, president of the European Health Forum Gastein, used the opening of the summit’s 28th edition in Austria’s Tauren mountains to sound the alarm that AI automation could hollow out the tax revenues that underpin Europe’s postwar welfare systems.

“AI will drastically change, even obliterate, the very foundations of the social contract as we know it today,” Auer said, arguing that the tax base funding Europe’s social provisions requires “total reformation” to preempt the coming transformation of the labour force and collapse of tax revenue.

“AI will transform societies, but may also devalue human labour, deepening inequality and creating instability,” Auer said. “The sustainability of solidarity systems is threatened at its core by this development and cannot be rendered future-proof unless the basis for funding of these systems changes.”

Europe’s social contract—the postwar consensus guaranteeing health, housing and education funded through employment-based taxation—is under attack from all sides as stagnating economic growth and ageing populations collide with budgets strained by war, climate change and digitalisation.

Demographics lead the assault. The EU’s active workforce is projected to shrink by 2 million by 2040, pushing the ratio of workers to pensioners from 3:1 to 2:1 as medical advances extend life expectancy and healthcare costs. Fewer workers mean less tax revenue even as spending on an ageing population rises.

“Society is changing in a positive way. We have lots of technological changes, new drugs, we can treat more diseases,” said Slovenia’s health minister Valentina Prevolnik Rupel. “In developed countries, the number of citizens does not really grow—what grows is the life expectancy. All this is positive, but it brings changes in demand, and needs are growing.”

Those same trends are pushing Europe’s medical workforce to the limit with a projected shortage of 4 million staff by 2030, despite increasing the import of foreign nurses by 67% and doctors by 54% over the last decade, according to WHO figures.

“If we keep the social contributions or the funding unchanged, and on the other hand, we see that the needs are increasing, we have some discrepancies that cause issues in trust,” she said.

‘Learn to speak Russian’

NATO Secretary-General Mark Rutte warned in July that nations face a choice between welfare system spending and defence.

Geopolitical tensions on European borders have intensified competition for scarce funds. Russia’s four-year full-scale invasion of Ukraine has forced a fundamental rethink of EU defence budgets, which stalled in a holding pattern around 2% of GDP in recent decades.

Nato allies are now pushing for member states to reach 5% of GDP in defence spending. The EU has already relaxed budget rules to allow member states to boost defence output, driving a 19% increase in defence spending across the bloc last year.

“If you do not do this, if you would not go to the 5%, including the 3.5% core defence spending, you could still have the National Health Service…the pension system, etc.,” Nato secretary-general Mark Rutte said ahead of a summit in The Hague in June. “But you’d better learn to speak Russian.”

“Sounds a little cynical,” Auer quipped, “but he said it.”

The landmark Draghi report on European competitiveness, released last month, estimates that investment in decarbonisation, defence, economic independence and digitalisation will require an additional 5% of GDP to keep pace with global powers in the US and China, a daunting figure given the bloc’s minimal economic growth and correspondingly stagnant government revenues.

“It’s high time to wake up and to start reflecting these political developments for our sector,” Auer continued. “All these developments will have a massive impact on how we finance, how we organise the level of and the access to health services.”

The 5% calculation in the Draghi report does not include health or pensions, which are largely absent from the document that charts the EU’s growth roadmap and investment priorities. Health and welfare budgets will have to compete for what’s left.

“You need additional money for the investment in infrastructure, that’s the fact. Through social contributions, we just fund the [social] programs,” Prevolnik Rupel said, noting that Slovenia has spent more in the last two years on health than in the previous decade combined to meet rising demand.

“That’s investments in the infrastructure—they are needed because the technological events are so fast,” she explained. “We need new equipment, we need new buildings, we need new spaces, because the protocols of how the patient travels through the systems change.”

Steam engine or hot air? 

The financial pressures on European welfare systems from demographic ageing, geopolitical instability and climate change are clear, as is the looming crisis in health worker shortages. The apocalyptic impact of AI that Auer outlined, however, remains far less certain.

In an essay accompanying his opening remarks, Auer compared AI’s potential to automate work processes to “the invention of the steam engine…and the First Industrial Revolution” in transformative power.

He cited Sam Altman, OpenAI’s chief executive, who predicted ChatGPT “will soon be more powerful than any person who has ever lived,” and Eric Schmidt, Google’s former chief executive, who forecast AI will reach 80 to 90% of top expert skills in mathematics, law, science and programming by 2033. Schmidt maintains one of the largest private AI investment portfolios worth billions of dollars.

Yet nearly all predictions of AI’s looming takeover come from inside the industry itself, where executives and investors have substantial financial stakes in the technology’s success. A significant decline in AI’s perceived value would cost companies like OpenAI hundreds of billions in valuation, and industry figures personally many billions of dollars.

The optimistic industry narrative has fuelled historic valuations despite record cash burn. The AI industry’s leading companies—Google, Meta, Microsoft, OpenAI, Amazon and Tesla—have spent a combined $560bn on capital expenditure since 2024 and generated just $35bn in return, netting $525bn in combined losses.

Despite the losses, OpenAI reached a $500bn valuation on Thursday, cementing its place as the world’s most valuable start-up.

The lack of profitability has contributed to growing concerns that the AI market might be a bubble, potentially undercutting its perceived revolutionary potential—and threat to solidarity systems in Europe.

AI’s capacity to “completely replace human work,” as Auer wrote, echoing warnings from other AI industry figures such as Anthropic’s Dario Amodei, has scarcely materialised.

A Yale University study published on Thursday found that US labour market metrics show “the broader labour market has not experienced a discernible disruption since ChatGPT’s release 33 months ago, undercutting fears that AI automation is currently eroding the demand for cognitive labour across the economy.”

Meanwhile, AI advancement has stalled as models hit walls in processing power, energy infrastructure, compute capacity and diminishing returns, all while companies have yet to identify profitable use cases for the technology.

A Massachusetts Institute of Technology report in August found that 95% of companies experimenting with AI are not making money from it, despite widespread promises from corporate leaders about efficiency gains.

Large language model technology is currently built on burning cash and the environment. Data centres consume more energy annually than all but 16 of the world’s 192 nations, with consumption set to double by 2030.

Global AI demand for water to cool servers and microchips is projected to require a supply equal to the total annual water withdrawal of countries like Denmark by 2027.

Continuing AI scaling and power-hungry data centres are eating into gains from green energy sources such as solar and wind, forcing gas, oil and coal plants back online to meet demand as air, noise and environmental pollution from digital waste threaten the health of nearby communities.

AI leaders including Altman have acknowledged that an energy breakthrough, likely from nuclear fusion, will be required if AI is to continue scaling. Google and Microsoft have started investing in nuclear technology, but a scalable breakthrough in the field is still a long way off.

“Naturally, historic predictions are difficult, especially when it comes to developments and employment in the labour market,” Auer acknowledged. “I do not want to oversimplify the issue here.”

AI’s healthcare promise 

If AI does fulfil its transformative potential, healthcare is seen as one of the most promising frontiers. Yet here too, the gap between promise and reality remains wide.

Nearly two-thirds of physicians surveyed in the United States reported using AI in 2024, a jump to 78% from 38% the previous year, according to a study by the American Medical Association. The usage, however, was primarily for administrative tasks such as documentation of billing codes, medical charts, visit notes, discharge instructions and translation services rather than medical or scientific breakthroughs.

Slovenia’s experience illustrates the challenge facing health systems. The government issued an open call for AI healthcare proposals and received 52 potential solutions for a country of just 2 million people.

“It’s like a flood of artificial intelligence applications, and we have to decide which ones to take on—and it’s very difficult because we don’t know,” Prevolnik Rupel said. “We don’t have enough evidence yet on which solutions work and which don’t.”

The government decided to pilot the most promising submission, an artificial intelligence program for scheduling healthcare workers’ shifts. Like the administrative applications in the AMA survey, the use case was organizational rather than medical, as doctors remain wary of trusting AI with decisions that could impact patients.

“Because it was an artificial intelligence, a logical program, it was more fair than when it was a nurse who would say, you do this,” she said. “Everybody was happy, and the level of satisfaction increased, and actually, the absenteeism among the healthcare workers fell in that hospital.”

The proliferation of untested AI applications has raised questions about how to regulate the technology safely. But experts say existing regulatory frameworks can be adapted rather than reinvented.

“When we started regulating medicines, 70 years ago more or less in the European Union, it was one of the first success stories,” said Natasha Azopardi-Muscat, division lead for WHO’s Europe office.

“We said medicines have to meet certain criteria: quality, safety, efficacy. And then we went further. We said that they have to be better than the alternative,” Azopardi-Muscat explained. “We can use the same [standards] for AI… We need to have a very clear system of evaluation.”

Despite the gap between AI predictions and current reality, Auer argued that political leaders are ceding crucial decisions about society’s future to private investors.

“If the automation stimulated by AI leads to a broad reduction of costs, meaning labour costs, meaning a significant loss of jobs,” he said, decisions about “how much capital to invest in development are made by financial investors, and not in parliaments or cabinet tables of governance.”

“The political call of the economic elites to strengthen Europe’s innovative power as forcefully as possible will come to nothing if at the same time we ignore the political concerns that innovations of the tech industry have the potential to dehumanize economic activity and weaken human labour,” he said.

“We must discuss and politically initiate steps to protect the solidarity systems in the long term and ensure the social and economic participation of as many segments of the population as possible.”

Image Credits: CC.

In April 2024, the Israeli Defence Force bombed Al Shifa Hospital, the largest hospital in Gaza.

All attacks on hospitals should be banned and the exceptions in international humanitarian law (IHL) that enable aggressors to justify bombing hospitals – by, for example, claiming that they are shielding combatants – should be removed.

Professor Neve Gordon, professor of international law at Queen Mary University in London, made this argument at a recent seminar hosted by the Geneva Graduate Institute’s Global Health Centre  and the International Geneva Global Health Platform. Queen Mary University, Médecins Sans Frontières (MSF) and the Graduate Institute’s Center on Conflict, Development & Peacebuilding co-hosted the event.

According to IHL, hospitals are protected from attack unless they are being used to “commit acts harmful to the enemy”, including shielding combatants and weapons.

But, said Gordon, this exception has now become the law, particularly in Gaza where “shielding has become a tool of genocide”.

The Israeli government claims that there are “hundreds of kilometres of tunnels under the Gaza Strip, and these tunnels are legitimate military targets, so anything above the target can be interpreted as a shield to the target”, said Gordon.

“Israel has targeted [hundreds] of medical units in the Gaza Strip, and each time it has claimed that these hospitals shielded something that belongs to Hamas,” he added.

“The vast majority of these claims are fabrications…. what you can see is how the law is being deployed by Israel, through the shielding argument, to defend and protect genocide,” he added.

“Anyone can decide what is proportional and what is not. Today, you kill two civilians for a soldier. Tomorrow, you kill 100 civilians for a soldier. And who can argue that that is not an adequate interpretation?” Gordon asked.

 “Part of the problem is the law. Let’s say there’s evidence of 10 combatants in a hospital. I say:” So what? We do not attack the hospital full stop. Wait till they come out, and you attack them.”

Massive increase in state attacks on hospitals

There has been a massive increase in attacks on health facilities, particularly by states.

Maarten van der Heijden, Global Health Centre research fellow,  showed that states were responsible for the majority of attacks on hospitals between 2016 and 2024, according  to the the Epidemic of Violence Report 2024 produced by the Safeguarding Health in Conflict Coalition.

There has also been a 1,000% increase in attacks on hospitals by states during this time.

“Attacks on healthcare are becoming part of the scorched-earth tactic, where you make a place unlivable,” said van der Heijden. 

After an Israeli attack on Nasser Hospital in August, the government of Prime Minister Benjamin Netanyahu used “multiple arguments” to justify the attack, based on denial, deflection and justification, he said.

“Netanyahu said it was a mistake. The military claimed that there was a [Hamas] camera. And then later, … they published a picture of six Hamas fighters that were attacked,” he said, adding that there was no clarity about how the Israeli military had assessed that the hospital was a legitimate target.

Deciding whether a hospital is a legitimate target requires a “complex analysis”, he added. “During a conflict, as we see right now in Myanmar, in Gaza, in Sudan, it is impossible to assess whether these attacks are actually legitimate or not.”

Lack of compliance

Professor Esperanza Martinez, head of Health and Human Security at the Australian National University’s law college, argued there was not an absence of legal frameworks but rather “an absence of compliance.”

“In 2024, there were more than 1,000 incidents directly targeting health facilities, hospitals primarily, and more than 80% of the attacks were committed by states,” said Martinez.

“So what we do have really here is a situation of widespread violations, impunity or lack of compliance and very limited enforcement.”

Professor Gloria Gaggioli, Vice-Dean for Research at the University of Geneva’s Law Faculty, agreed that IHL is sufficient and that exceptions to hospital attacks are important.

“Is the exception the problem? I don’t think so, because imagine a situation where we would say all attacks on hospitals are prohibited, and it’s a crime. What would be the result? The result would be that the enemy would have an incentive to use hospitals for military purposes,” said Gaggioli.

Moderator Ellen Rosskam with panellists Neve Gordon, Gloria Gaggioli and Tarak Bach-Baouab, with Esperanza Martinez on screen.

Plea from the field

“IHL doesn’t work,” said MSF’s Tarak Bach-Baouab. “We have the lives of our patients, the lives of our staff in our hands, and we have to have an environment where all the rules are well understood by all the players, and in which we can continue to operate.

“We have a larger problem than compliance. The law is actually used to justify attacks on health care, and the onus today is put on practitioners like ourselves, working in hospitals in conflict zones, to prove that the hospital is not used for a military purpose, or is not used as a shield,” added Bach-Baouab, who heads advocacy for MSF’s Operations Management Team.

“It used to be that the military contemplating attacking a hospital needed to go through almost a checklist before being able to attack. Today, the onus of proof has been turned on its head, and I think this is a major problem we are facing as humanitarians in conflict zones.”

He called for mobilisation by medical associations across the globe against these attacks and in support of the implementation of resolutions such as Resolution 2286 on the protection of health care, which was passed almost 10 years ago.

He also challenged the Swiss government, as the host of the Geneva Convention adopted at the end of the Second World War, to step up as guardians of IHL and push for “stronger uptake of these rules”.

How many civilians is it acceptable to kill in pursuit of a military target, Bach-Baouab concluded? 

MSF’s health facility in Al Shifa Hospital compound was severely damaged in the attack on the hospital in April 2024.

A complete recording of the event is available at the GHC You Tube Channel. 

Image Credits: Olga Cherevko/ OCHA, MSF, Safeguarding Health in Conflict Coalition.

Dr Kate O’Brien, WHO director of Immunisation, Vaccines and Biologicals

Vaccinations have saved the lives of an estimated 17 million people between 2021 and 2024 – but global immunisation programmes face several challenges, according to an assessment by the World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunisation.

Dr Kate O’Brien, WHO director of Immunisation, Vaccines and Biologicals, acknowledged the “deep commitment of countries and communities around the world to vaccination” at a media briefing on Tuesday following SAGE’s biannual meeting. 

While vaccination coverage has largely rebounded to pre-pandemic levels, “backsliding in Gavi-ineligible middle-income countries, and an increasing number of people living in fragile and conflict settings, threaten the global gains”, according to the WHO.

Immunisation programmes are being tested by “geopolitical instability”, constrained global and national budgets, and “shifting health architectures”.

In addition, “the information and trust crisis threatens vaccine confidence and uptake”, WHO noted.

However, O’Brien stressed that “the vast majority of parents are strongly supportive of vaccines”. 

“The rollout of malaria vaccine on the African continent, one of the fastest rollouts that we’ve seen, is a testament to the impact of vaccines, and the deep desire for people to protect their children to family members from infectious diseases that are otherwise a daily occurrence,” she said.

Four malaria vaccine doses affirmed as ‘optimal’

Harvard Professor Dyann Wirth, chair of the Malaria Policy Advisory Group (MPAG)

SAGE confirmed that four doses of the malaria vaccine, known as RTS,S/AS01, provide optimal protection over three doses in preventing the rebound of severe malaria.

This decision was informed by a four-year study, which included children under five years of age, conducted in Ghana, Kenya and Malawi, where the vaccine is being rolled out as part of the routine childhood immunisation programmes.

“The fourth dose reduced severe malaria by 54%, with a 30% incremental effectiveness, above that provided by three doses,” said Harvard Professor Dyann Wirth, chair of the Malaria Policy Advisory Group (MPAG).

“The cumulative effectiveness of the four doses in reducing cerebral malaria, one of the most severe and deadly manifestations, was 74%,” added Wirth. In comparison, three doses reduced cerebral malaria by 48%.

“While three doses provide safe and effective protection against clinical malaria and severe disease, the incremental effectiveness of the fourth dose against severe disease was substantial,” she added.

SAGE chair Dr Hanna Nohynek

SAGE chair Dr Hanna Nohynek said at least 20 countries were using or considering the malaria vaccine, and SAGE recommends aligning the vaccines with other childhood vaccinations where possible.

SAGE “supported the expanded use of the novel oral poliovirus vaccine (OPV) to reduce vaccine-derived polio virus transmission in select geographies with persistent transmission of this particular virus”, said Nohynek.

It also recommended the use of “fractional doses of Sabin-based inactivated poliovirus vaccines (IPV)”.

Dr Joachim Hombach, SAGE’s executive secretary, highlighted the importance of countries “establishing programmes to support trust in vaccines, the safety of vaccines and the impact that they have, as they are “one of the most cost-effective health interventions”.

Hombach stressed that SAGE is an independent group of experts that base their decision on scientific evidence not politics.

Dr Joachim Hombach, SAGE’s executive secretary

O’Brien stressed that “the economic return on investment of vaccines is probably one of the highest available”.

Over the past 50 years, vaccines have saved approximately 154 million lives – and the measles vaccine is responsible for saving around 60% of these deaths, she noted.

US vaccine decision

The US recently decided to recommend two separate vaccinations for children – a combined one for measles, mumps and rubella (MMR), and another for varicella (chicken pox) – instead of a combined MMRV vaccine for all four conditions.

O’Brien said there were a range of vaccines available for the four common childhood infections, and that clinical trials have been done to assess the safety and the performance of the vaccines when they’re put together in a combination.

“Combination vaccines have a lot of benefits to them, especially from the perspective of the child, as it’s fewer injections, and  fewer number of visits to the healthcare provider,” said O’Brien.

“It’s well known that the measles, mumps, rubella and varicella (MMRV) combination vaccine does have a higher risk of fevers following the vaccine than when the varicella vaccine is given separately,” she added, and that these fevers could result in “febrile seizures”.

“A number of different countries constrain the recommendation for use of that combination vaccine to those kids who are older,” she said, but stressed that the MMR vaccine is “very safe”.

As measles and rubella have “significant health risks”, the WHO recommends that countries vaccinate against these two illnesses and this is using given in a combination vacine, she added.

SAGE also reported a decline in reported COVID-19 cases and deaths in the past year, along with low annual vaccination uptake “mainly limited to high-income countries in the WHO regions of Europe, the Americas and the Western Pacific in 2024”.

Variant-adapted COVID-19 vaccines show “moderate” effectiveness in preventing COVID-19 cases and hospitalizations, though protection wanes by six months, said SAGE.

“SAGE recommended an updated review of the evidence on the effectiveness of COVID-19 vaccines during the Omicron period, with a focus on the effect of vaccination in pregnancy on birth outcomes and infant COVID-19 to reassess the validity of recommendation on vaccination during pregnancy, in the current epidemiological context,” said the body.

SAGE also noted that there are 16 candidate tuberculosis vaccines in clinical development, five of which are in phase 3 trials. One, known as M72/ASO1E, could be licenced as early as 2028, depending on trial results.

Chhattisgarh health workers on strike

CHHATTISGARH, India — Nearly 16,000 staff employed under India’s National Health Mission (NHM) have been on an indefinite strike since 8 August. In early September, the dispute escalated dramatically when the state government dismissed 25 union leaders, prompting the mass resignation of  more than 14,000 health workers.

The mass resignations have raised alarm about the stability of healthcare in Chhattisgarh, a heavily forested, predominantly rural state that is home to 32 million people.

While clinics and outreach programs are still functioning in some areas, experts warn that if the strike persists, immunisation, maternal health services, and disease control programs could face severe disruption, leaving patients in remote tribal districts without access to even the most basic care.

“We were called COVID warriors during the pandemic. We reached villages no one else could,” said a health worker from Raipur, speaking on condition of anonymity. “But what are we getting in return?”

At the centre of the standoff are demands for permanent contracts, pay parity with regular staff, and improved benefits. Union leaders say the dispute in Chhattisgarh is not an isolated battle, but a symptom of deeper structural problems in India’s health system – problems that resonate globally.

Demands behind the strike

Health workers under NHM, the country’s flagship public health program launched in 2005, are technically “contractual staff.”  They receive lower pay, fewer benefits, and no job security compared to state-employed counterparts, despite often performing identical roles.

“We have 10 demands, and our top priority is regularisation or at least grade pay equal to permanent health workers,” said Hemant Kumar Sinha, leader of the trade union, Chhattisgarh Pradesh NHM Karamchari Sangh, in an interview with The Indian Express.

Other demands include the creation of a dedicated public health cadre, annual performance evaluations, a 27% salary hike, cashless medical insurance worth at least one million rupees (around $12,000), and expanded leave and medical benefits. 

In mid-August, the executive body of the State Health Committee accepted four of the 10 demands raised by contractual NHM employees, but trade union leaders insist that all their demands must be accepted and implemented.

Chhattisgarh health workers say they deliver services in hard-to-reach villages that permanent workers do not service, yet have no job security or pay parity.

Precarious national workforce

The unrest in Chhattisgarh highlights a paradox: India has rapidly expanded its health workforce in recent years, but much of this growth rests on insecure contracts.

Between 2021 and 2024, more than 1.2 million professionals – including medical officers, specialists, nurses and public health managers – have been inducted nationwide under NHM, according to official data. 

The number of community health officers alone rose from 90,740 in 2021–22 financial year to more than 138,000 by 2023–24.

“Yet we continue to work without security or parity,” Sinha said. “Our services are treated as dispensable, even though the system cannot function without us.”

Similar grievances have flared across India. Earlier this year, NHM staff in Maharashtra staged protests after going without pay for three months. Workers in Bihar, Uttar Pradesh and Madhya Pradesh have launched strikes over delayed wages in the last few years , lack of insurance coverage, and stalled promises of regularisation.

Health policy analysts warn that the over-reliance on contractual staff is not just a labour issue but a systemic risk.

“Primary health care in India is essentially running on precarious contracts,” Ankita Verma, a Delhi-based public health researcher told Health Policy Watch. “When those workers withdraw, the entire rural delivery chain collapses.”

The situation is particularly critical in Chhattisgarh, where tribal populations in remote forested areas depend almost entirely on NHM workers for services ranging from maternal health to malaria control. Prolonged disruptions, experts say, could roll back years of progress in child immunisation and communicable disease surveillance.

Chhattisgarh health workers are sticking to their 10 demands.

Global temporary worker crisis

The crisis in Chhattisgarh is not unique. Around the world, governments have leaned on temporary or flexible contracts to stretch health budgets and scale up ambitious programs, often with similar results.

In Kenya, nurses employed under the Universal Health Coverage (UHC) programme in coastal counties have staged repeated strikes over short-term contracts, unpaid allowances, and lack of permanent status. 

Workers in the Kenyan towns of Mombasa, Kilifi, Kwale, Lamu, Tana River, and Taita Taveta demanded conversion to permanent and pensionable terms, arguing that constant uncertainty undermines service delivery.

In Nigeria, doctors in public hospitals walked out in September 2025 over unpaid salaries, wage arrears, and insecure postings. The strikes disrupted services in Abuja and other cities, adding pressure to an already strained system.

Labour analysts say these parallel struggles expose a global fault line. “The pandemic briefly highlighted the indispensability of frontline health workers,” said a global labour rights advocate while talking to Health Policy Watch. “But once the emergency faded, many governments reverted to treating them as expendable.”

Health toll mounts

For now, the standoff shows little sign of resolution. Health workers say they will not return to work unless their demands are met, while the government has so far doubled down by dismissing union members.

But the human toll is mounting. If the condition persists in the districts, people  may have to walk miles to private clinics and pay for services. Pregnant women in rural areas have to be referred to distant hospitals, often beyond their means to reach.

The state, in the centre-east of India, has a tropical climate that is one of the most climate-vulnerable states, experiencing extreme weather events,  including floods, heatwaves and droughts, according to the India’s Ministry of Health and Social Welfare. 

“Chhattisgarh is a state with the highest mines and mineral-based industries and air pollution is one of the biggest threats to the health of the population,” according to the Ministry. Heavy metal contamination of the soil is also a problem.

Malaria and dengue are prevalent in the hilly north and south, while other zoonotic diseases are increasing due to climate change.

Health advocates warn that if the strike drags on, Chhattisgarh could see rising maternal and infant mortality rates, surges in preventable diseases, and widening inequities in care.

“This isn’t just about wages,” said Verma, the Delhi-based public health researcher Verma. “It’s about the sustainability of India’s healthcare model.”

Test case for India 

The crisis poses a test not just for Chhattisgarh but for India’s approach to public health delivery. Can the country sustain an expanding workforce without offering stability and parity? Or will repeated cycles of protest and disruption continue to erode public confidence?

Globally, the lessons from Chhattisgarh may be equally pressing. As governments grapple with growing health burdens, many have opted for contract-heavy models that prioritise flexibility and cost-saving. But the fragility of such systems becomes apparent the moment workers walk away.

For the health worker from Raipur, the issue is less abstract. “We don’t want to abandon our patients,” she said. “But if the government treats us as disposable, how long can we keep going?”

Image Credits: Chhattisgarh Pradesh NHM Karamchari Sangh.