Supporters of the Swiss Climate Seniors Association “KlimaSenirorinnen” outside the European Court in Strasbourg, which ruled Tuesday that Switzerland’s climate policies were putting older women’s lives at risk.

A European Court ruling Tuesday that Switzerland was violating human rights by not acting fast enough on climate change has been hailed by legal experts as a global precedent – and by WHO Director General Dr Tedros Adhanom Ghebreyesus as an important recognition of the links between climate change and health.

In a case brought by the Swiss-based association of “Senior Women for Climate Protection” the Strasbourg-based European Court of Human Rights (ECHR) ruled that Swiss government inaction was putting their health at risk due to “critical gaps” in carbon reduction policies.

The women, aged 64 and over, had argued that more extreme heat episodes, driven by climate change, undermined their health and quality of life, and put them at a greater risk of dying.  A growing body of scientific evidence has documented the links between exposure to extreme heat and premature mortality -with heat relaed deaths of people over age 65 increasing by 85% since 1990, according to a Lancet Countdown study, published in November, 2023.

The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change, Lancet found in a global report by an international consortium of 114 scientists. Pardoxically, while the European Court ruling recognized the risks borne by older women in Alpine Switzerland, the overwhelming burden of those heat-related health risks is born by older people in low-income countries.

Lancet Countdown: Average annual hours per person from 1991 to 2022 when light physical activity entailed at least a moderate, high, or extreme heat stress risk, arranged by HDI=Human Development Index groupings.

A European and global precedent

Today’s ruling against Switzerland sets a historic precedent that applies to all European countries,” said Gerry Listen, attorney at the Global Legal Action Network. The Network had represented a group of Portuguese children in a similar climate-related case before the European Court, which was ruled inadmissable for procedural and technical reasons.

Listen said that the favorable ruling on the Swiss case, nonetheless, means that “all of the government lawyers who represented the 32 respondent states in our case are now going to have to advise their governments, the governments that they represented, that they are going to have to look at their targets again and update them.

“Because none of the governments in Europe in cases that were before the court today have targets that are anywhere near 1.5 C.  Most targets are aligned between 3-4 C within the lifetime of the young people before the court today,” he added in an interview on CNN Television.  “So absolutely catastrophic levels of warming. So this precedent will require European wide revision of climate policies urgently. Otherwise, or anyways we are going to see a new wave of climate litigation at the European level sparked by this ruling from Strasbourg today.

The court ruling is particularly significant because it is legally binding for Switzerland, and potentially for other European countries as well. However, litigation on climate issues has become increasingly common around the world. Both the International Court of Justice and the Inter American Court of Human Rights have cases pending which relate to the human rights impacts of climate change.

As a result, the ruling will have impacts far beyond the European region, Joanne Setzer, Associate Professor at the UK-based Grantham Research Institute on Climate Change and the Environment, told the a English-language media channel, Swissinfo.ch.

“The landmark ruling by the European Court of Human Rights not only sets a precedent in environmental and climate law but also signals a momentous shift in the global legal landscape concerning climate change,” she said.

Only recently, India’s Supreme Court also recognized that the adverse effects of climate change violated people’s fundamental constitutional rights. There have also been a flurry of new reports and evidence suggesting that climate change disproportionately affects women and their health.

In the ECHR ruling, Siofra O’Leary, president of the ECHR found numerous “critical gaps” in the Swiss regulatory frameworks that are supposed to reduce climate change. The court also criticized the lack of an effective Swiss monitoring system to determine levels of emissions that could indeed be permissible, while limiting warming to 1.5 °C in line with the 2015 Paris Climate Agreement.

Eight year battle

Despite it’s “clean and green” reputation, Switzerland ranks among the “laggards” in economic incentives for zero emissions vehicles, according to a 2022 study.

The Swiss senior’s association launched its legal case in 2016, charging the Swiss authorites for pursuing ineffective climate policies, which therefore threatened their health and right to life. The Swiss Federal Supreme Court rejected their request that the state adopt more ambitious targets for reducing climate emissions. Then in 2020, the Association appealed to the ECHR, anchoring its case in the violation of the European Convention on Human Rights, including clauses related to the right to life.

The ECHR’s binding judgment means that Switzerland must take action to comply with the order – enacting new legislation to bring Swiss emissions reductions in line with the global goals of keeping temperature increase below 1.5 °C.

Despite it’s global reputation as a clean and environmentally conscious nation, including solar panels on many rooftops and an efficient rail and cycle network, there has in fact been considerable pushback by Swiss center and center-right parties against more aggressive climate action – popularly perceived as adding to economic costs and undermining personal autonomy.

Only one in 50 vehicles are fully electric, and Switzerland is one of the “laggards” in the tax incentivization of private, zero-emissions vehicles, according to a 2022 study by the NGO Transport & Environment. Even so, Switzerland now plans to end tax exemptions for EVs in 2024.

Image Credits: @GLAN_LAW, Lancet Countdown on Health and Climate Change , Transport&Environment.

Checking for standing water
Dengue cases have increased fourfold in some parts of the Americas

As global cases of dengue are already close to last year’s record high of over four million, the Americas region is struggling to contain high transmission levels. Unplanned urbanization, heavier rainfall, warmer temperatures, and the El Nino effect create perfect conditions for the Aedes aegypti mosquito, the primary vector of dengue. 

The Southern Cone region of the Americas, which includes Argentina, Brazil, Chile, Paraguay, and Uruguay, has seen the highest burden of cases and deaths. Brazil alone accounts for close to 3.5 million cases

Challenges with vaccine distribution and availability

This year, Brazil became the first country to deploy a newly approved vaccine, Qdenga. The vaccine, manufactured by the Japanese-based pharmaceutical company Takeda Pharmaceuticals, contains weakened versions of all four dengue serotypes. The European Medicines Agency and the UK have approved the vaccine for use in adults and children over four years of age. 

However, the manufacturers can only produce about six million doses – enough for  three million individuals as each person needs two doses.

Currently, Brazil is distributing the vaccine to children between the ages of 10 and 14 in areas of high transmission, and with previous exposure to dengue. This represents only a fraction of Brazil’s population. 

“[T]hey chose this age group because it was based on the analysis of the Minister of Health, the age group that was suffering the highest burden of hospitalization,” explained Dr. André Siqueira, a tropical medicine doctor and clinical researcher in Fundação Oswaldo Cruz, in a recent interview with the One Health Trust.

“We can’t expect that to have a huge effect on the epidemics because it’s a restricted age group and it’s not the whole country. Full immunization is achieved within three months from the initial dose.” 

Given these limitations, the vaccination campaign is controversial in Brazil. “Some people said there’s no point. Even the Minister of Health said it won’t have any impact on this epidemic,” said Siqueira.

However, Siqueira notes that vaccinating this initial cohort creates momentum “of people being involved with dengue to start promoting the vaccination, showing that it is safe and it can have an individual impact.” 

Public support is especially important after a prior vaccine, Dengvaxia, was linked to deaths in children in the Philippines. 

The Sanofi-produced vaccine was mired in controversy after the vaccine was shown to increase the risk of hospitalization for those without prior dengue exposure. When these individuals were infected with dengue, “instead of being protected, they were at higher risk of severe disease.” 

This is due to the dynamics between the four dengue serotypes. The antibodies for one serotype will only protect the individual against future infection from that same serotype. Individuals could then have up to four episodes of dengue over a lifespan. Furthermore, interactions between antibodies from the various serotypes can lead to more severe secondary dengue infection, a process called antibody-dependent enhancement

This dengue season in Brazil has seen the circulation of all four dengue serotypes. Many Brazilians are especially vulnerable to DENV-3 and DENV-4 as these subtypes have reappeared this season. 

Vaccine trials for domestically-produced doses

In light of these challenges, researchers in Brazil are in the process of developing a new dengue vaccine to target all four serotypes. The vaccine, from the Butantan Institute in collaboration with the US National Institutes of Health (NIH), shows early promise in clinical trials. The live, attenuated, tetravalent vaccine requires only one dose, unlike Qdenga, which uses a two-dose system with three months between shots. 

In phase 3 trials, the vaccine has shown an efficacy of 79.6% among those without prior dengue exposure, and 89.2% for those with prior exposure. The results, published in The New England Journal of Medicine, are a culmination of years of research and trials, and bolster Brazil’s hopes for disrupting dengue’s hyperendemicity. 

“It should be stressed that Butantan Institute’s vaccine has also proved extremely safe for people who have never had dengue, which is an advantage over the vaccines now available on the market. Furthermore, it can be administered to a broader age group and a single dose is sufficient,”said  virologist Maurício Lacerda Nogueira in a press release



Image Credits: PAHO/WHO.

Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks.

A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. 

“Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance.

Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae.

It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide.

Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights

It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread.

A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade.

Rapid testing

Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread.

Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030.

Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. 

“We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.”

Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests.

Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.”

The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030.

 

Image Credits: UNICEF.

Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK.

Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease.

Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks.

“Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance.

“More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” 

Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions.

Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma.

Negative attitudes 

“When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls.

“I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. 

According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings.

In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. 

Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression.

Ending stigma, ending hepatitis

Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.”

The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination.

As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted.

A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment.

“I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.”

 

Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time.

The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response.

Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday.

WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”.

In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia.

However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases.

“It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. 

During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East.

From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme.

In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic.

Image Credits: Lindsay Mackenzie/ WHO.

Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines.

There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need.

This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal.

New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022.  Hepatitis B and C cause around 3,500 deaths every day.  

Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission,  and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality.

“Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening.  This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance.

“This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.”

WHO’s Dr Meg Doherty and report author Dr Francoise Renaud

“Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.”

According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment.

Almost two-thirds of global cases are concentrated in 10 countries –  Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam.

Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. 

“Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty.

On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular.

“There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. 

Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022.  Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases.

Treatment costs

Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements.

“Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.”

For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia.

Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark.

The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000.

About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for
viral hepatitis diagnostics

Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge.

Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. 

Image Credits: Yoshi Shimizu/ WHO.

An artist's depiction of artificial intelligence.
An artist’s depiction of artificial intelligence.

Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health.

To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare.

“Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said.

The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations.

“Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch.

He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application.

“We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added.

HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.”

Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations.

The future of AI in healthcare (illustrative)
The future of AI in healthcare (illustrative)

Regulatory confidence in technology

There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions.

HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards.

“This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.”

At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action.

“This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said.

WHO Announces S.A.R.A.H.

HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI.

S.A.R.A.H stands for “Smart AI Resource Assistant for Health.”

“For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.”

S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes.

“S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

Image Credits: Quick Creator, Pexels.

Sudanese women are being targeted by soldiers using rape as a weapon of war.

The “weaponization of sexual violence” during conflicts is a major challenge facing the health sector, and it needs the serious attention of the international community, said World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreysus.

Tedros broke down  while recounting that his own cousins had been raped and his uncle had been killed during recent violence in Tigray in Ethiopia as gender-based violence has become an instrument of war.

“Tens of thousands of women have been raped during that conflict, and there is no capacity in the region or within WHO to handle it. But you see it not only in Ethiopia, but you see it in DRC, you see it in Haiti, you see it in Sudan. You see it everywhere,” said Tedros during a  high-level dialogue with UN High Commissioner for Human Rights Volker Türk in Geneva on Monday – a day after International Health Day and the WHO’s 76th anniversary.

Tedros admitted that addressing gender-based violence was “beyond the capacity” of the WHO.

“I say beyond our capacity, or beyond the capacities of any player I know in conflict,” said Tedros.  “Many thousands of women haven’t received any services whatsoever – nothing, zero – and it’s the same in many countries where there is active conflict,” said Tedros.

“The magnitude is so high, and the international community should take it seriously,” he stressed, adding that women didn’t just need medical services, but psychosocial support.

Strategic dialogue with OHCHR

UN High Commissioner for Human Rights Volker Türk recalled that a number of countries, including Sudan, denied that their soldiers were involved in rape “but it happens in every army”.

Türk proposed a strategic dialogue between his Office – known as OHCHR – and the WHO to address human rights in the health sector and how to secure the right to health.

The two organisations have a framework of cooperation, said Türk, but they hadn’t been able to “bring it to the next level” during the pandemic.

“I think it would be good to take stock, and look strategically at how both worlds can be much closer together on a number of fronts,” he proposed – with Tedros immediately agreeing to a meeting during the course of the year.

 

The two leaders also raised the deliberate targeting of health facilities during conflict and the impact of this on health workers, and the high fatality rates of civilians in current conflicts. The WHO has documented the destruction of 300 health facilities and the deaths of 742 health works in this year alone.

Türk said that after “two massive world wars, after atrocity crimes, horrible war crimes, the Holocaust, and the Great Depression, there was a real recognition that, when it comes to health in conflict, hospitals and medical personnel are sacrosanct”.

But this has been replaced by a “flagrant blatant disregard for the laws of the war when it comes to hospitals and medical personnel”, he added.

In Syria, Ukraine and Gaza, there had been an almost deliberate targeting of hospitals and of health personnel, said Türk, who described what is happening in Gaza as “an unmitigated disaster” with “hardly any health facilities working”.

“We need to regain the space of the normative values that go back to the origins of why it is important to protect healthcare personnel, and health infrastructure in all situations around the world. I mean, we are talking about 55 active conflict situations,” he added.

‘Target fossil fuel’

The two leaders also raised the impact of changing climate on health, with Tedros supporting the focus on phasing out the use of fossil fuels, which is responsible for “70% of greenhouse gases.

“Because of climate change, asthma is on the increase. Cardiovascular diseases are on the increase. Vector borne diseases like malaria, dengue are actually invading places they have never been known before,” said Tedros.  

Dr Tedros Adhanom Ghebreyesus

“Universal health coverage is a question of rights, and it has to influence the budgetary decisions that states make, and which brings us to the issue of the human rights economy,” said Türk. 

“If there was any lesson to be learnt from a COVID pandemic, it is precisely that it is that you need to have universal health coverage in order to be able to deal with the big challenges or the stress factors that a pandemic can unleash,” he added.

“We want to be sure that we’re prepared for whatever comes next, and universal health coverage is absolutely critical, both in terms of rights, but also in terms of sustainable development for any country in the world.”

Image Credits: CC.

WHO and UN agency officials survey the ruins of Al-Shifa’s Emergency Department during a visit Friday, April 5.

Speaking out on World Health Day, WHO Director General Dr Tedros Adhanom Ghebreyesus decried the destruction of Gaza’s Al-Shifa hospital and blamed Israel for the devastation, saying that the “atrocity” of the Hamas attacks on Israeli communities 7 October, did not justify “the horrific ongoing bombardment, seige and health system demolition by Israel in Gaza.”

He made his remarks Sunday, two days after the first WHO visit to Shifa Hospital following the 1 April withdrawal of Israeli forces from the hospital compound after a fierce two-week battle with Hamas forces in and around it.

“It has been six months since the brutal attacks in #Israel by Hamas and other groups, in which 1,200 people were killed, many more injured and hundreds abducted,” Tedros said in a post on X, of the 7 October events that triggered the war. 

@WHO once again condemns this barbaric act of violence and demands the release of remaining hostages. However, this atrocity does not justify the horrific ongoing bombardment, siege and health system demolition by Israel in #Gaza, killing, injuring and starving hundreds of thousands of civilians, including aid workers.

“The deaths and grievous injuries of thousands of children in Gaza will remain a stain on all of humanity…. The denial of basic needs – food, fuel, sanitation, shelter, security and healthcare – is inhumane and intolerable,” said the director general. 

Images of the hospital taken during the UN inter-agency visit, which included WHO, OCHA and other relief organisations, highlighted the degree of damage done, with the hospital’s emergency surgical and maternity departments, in particular,  reduced to unrecognisable shells.

“As WHO marks World Health Day … under the theme ‘My health, my right,’ this basic right is utterly out of reach for the civilians of Gaza,” said a WHO statement shortly after the mission took place, noting that prior to the beginning of the war, Shifa had been the largest and most important referral hospital in Gaza.

“Of the 36 main hospitals that used to serve over 2 million Gazans, only 10 remain somewhat functional, with severe limitations on the types of services they can deliver,” said the WHO statement, noting that “access to health care in Gaza has become totally inadequate, and the ability of WHO and partners to help is constantly disrupted and impeded.

“The proposed military incursion into Rafah can only result in further diminution of access to health care and would have unimaginable health consequences.  The systematic dismantling of health care must end.”

The WHO comments on Shifa triggered a sharp reaction from Israel’s ambassador in Geneva, Meirav Eilon Shahar, who accused WHO of “complicity” in its silence over Hamas militarisation of the hospital that Israel says triggered the two-week invasion in which several hundred Hamas gunmen, including a number of senior Hamas leaders, were reportedly killed.

“It’s not just the 133 men, women and children which are held hostage by Hamas, it’s the entire Palestinian civilian population and their infrastructure including hospitals and schools,” said Shahar in an X post.

Hundreds of terrorists in Shifa. Silence. Hostages taken to hospitals on October 7. Silence. Weapons found in incubators. Silence. Rockets founds in wards. Silence. The last 6 months. Silence from @WHO on Hamas, and its abhorrent strategy. Silence is complicity.”

World Health Day, celebrated every year on 7 April, marks the anniversary of the founding of the World Health Organization in 1948.

Image Credits: OCHA .

Ukrainian family flees over the border on foot in March 2022, following Russia’s invasion of the country.

Victims of conflict face a double or triple whammy when trying to cope with mental health challenges. Even the most resilient may begin to experience symptoms of anxiety, anger and sleeplessness during wartime that last decades. And those with pre-existing conditions are forced to cope with the acute trauma provoked by experiences of death, destruction and displacement at the same time as any chronic condition, for which they may be unable to get medications or support. 

The issue was the focus of a recent online eventNo Peace of Mind” organised by the Global Health Centre of Geneva’s Graduate Institute and the UK-based charity Beyond Conflict, in which experts with experience dealing with ongoing conflicts in Ukraine, Kashmir and the Palestinian West Bank and Gaza spoke about the myriad of challenges they faced. 

Mental health alongside physical care in emergency settings

Mariana Duarte, Médecins Sans Frontières (MSF)

Panellists emphasised the need for health and humanitarian relief organisations to recognise the need to provide mental health support to conflict-affected populations, along with other emergency health services. 

In prolonged conflict settings, long-term investments in culturally sensitive and accessible care are important, they stressed. Building awareness about self-care as well as more training for family practitioners in the identification and treatment of mental health conditions can help overcome the dearth of resources, as well as building more resilient community services that also counter-balance the historical focus on hospital-based care.  

“We cannot allow a lack of resources to be an excuse for neglecting the basic needs of people who are suffering,” said Mariana Duarte, a mental health advisor to Médecins Sans Frontières (MSF). 

“Integrating mental health into emergency response requires collaboration amongst various sectors including health, social services, education and community organisations,” she stressed. 

At the same time, she added, the responsibility of health actors does not end with the provision of services.

“We must also address the underlying cause of armed conflicts and work tirelessly to promote peace, justice, and reconciliation.” Duarte said. “Only by addressing the roots of conflict, can we hope to create a world where mental health is protected and valued.”

Addressing mental health after the conflict ends  

Edna Fernandes, co-founder Beyond Conflict

If war- related traumas are not resolved, then they continue to create illness long after the hostilities have ended, noted Edna Fernandes, the co-founder of the charity Beyond Conflict and moderator of the session. 

She helped found the organisation after  life-changing interactions with two refugees from Iraq who fled Islamic State in 2016.  One was a young woman that she met at an IDP conference in the United Kingdom who had escaped sex trafficking but remained “full of rage.” 

“When I asked her privately what was the one thing that would make a real difference, she surprised me because she said ‘we simply need more psychiatry.’”  

The second was an 10 year-old boy who had escaped ISIS and after three months in an IDP camp, barricaded himself into a room with two small children ages 2 and 3, which he then hanged.  

“So the 10-year-old was repeating the cycle of terror and violence that he had learnt from ISIS,” she said. “Through these two refugees, we first learnt about the lack of mental health support for victims of war and conflicts around the world.”  

Since being founded in 2018, the charity has worked with Rohingya refugees from Myanmar living in Bangladesh;  Ukrainian refugees, and since January, a project for Palestinians in the West Bank and for Israeli young people who were traumatised by the 7 October Hamas attack on the Nova Music Festival.  

“In all cases, we support expert partner organisations on the ground who know the cultural landscape inside out”,” she said. “Yet despite growing awareness and an understanding of the long term cost of failure to address more related trauma, the huge demand for mental health support remains largely unmet.”  

Psychiatric conditions exacerbated during acute crises  

Displaced Palestinians walk from the north of Gaza towards the south in January 2024 after Israel ordered their evacuation during its war on Hamas.

Expert panellists from Ukraine; Jammu and Kashmir, and the Palestinian West Bank, provided their insights into mental health trauma in three conflict-ridden parts  of the world.  

“Presently, the only psychiatric hospital in Gaza has been ravaged by war,” said Mohammad Marie, an assistant president at An-Najah’s College of Medicine in the West Bank city of Nablus. He described the urgent challenges faced in an active conflict setting, where life-threatening threats to physical health create new mental health scars that add to those previously experienced.  

“Psychiatric patients in Gaza are living without medication,” he declared. “But in addition, children’s [limbs] are being amputated without anaesthesia; women are undergoing caesarean sections. 

“This catastrophic situation leads to death, or people live with mental health scars for the rest of their life,” he said. “There is no mental health care in Gaza. There is no medication, especially psychiatric medication. In Gaza. In addition to that, there is no food, no clean water.” 

And even amongst Palestinians in the West Bank, where Marie lives, the war has changed their lives, as the Israeli military occupation around them tightens its grip. 

“I live in Nablus, for example, and personally I have been unable to move outside of my city for the past six months. I feel suffocated, unable to travel,” he said.  

In both the West Bank and Gaza, decades-long waves of conflict, along with the accompanying feelings of helplessness and hopelessness,  have left people in an unending cycle of intergenerational trauma, he added. 

“And each trauma is more difficult or more severe than in the past.” 

When the bombs stop falling the real struggle of people starts 

Saiba Varma, bottom left, describes particularly vulnerable population in the Jammu Kashmir context.

Sometimes it can feel very difficult to talk about mental health in the context of conflicts, added Saiba Varma, an associate professor of psychological and medical Anthropology at the University of California, San Diego.  

“It makes you sometimes question why is this important given what people are going through?  But I have to always remind myself that it’s what happens after the bombs stop falling,” Varma said. “That’s when, in many ways, the real struggle of people starts. And as an anthropologist, when I’m thinking about the relationship between mental health and war and occupation.” 

In complex and ongoing long-term conflicts, the “war on the psyche” persists even if bombs are not falling every day, she explained. 

“It is a war that targets people’s perceptual reasoning, decision making and behavioural capacities. It is very explicitly a war that does not only target soldiers and combatants, but ordinary citizens,” Varma continued. “For example, in the region of Jammu and Kashmir, the Indian government does not see it as an ongoing occupation. It does not see it even as a war. It sees it as a place of terrorism, whereas when you talk to people from Jammu and Kashmir they will name this as a war, as an occupation.

“So even the ways in which we name these conflicts are imbued with ambiguity. That, I think, is a sort of psychic assault on people’s ability to reason and make sense of their world. That’s where it really begins, in terms of the mental health challenges that are particular to Kashmir but certainly not unique.”

Varma noted that a lot of research on trauma and PTSD is based on people who have fled places of violence. However, in places like Kashmir, the population continues to live in the traumatic environments.

“Amongst the vulnerable populations in Kashmir, as in other conflicts, we’re seeing very high rates of substance use in children and youth,” Varma said. “In women, we’re seeing increased rates of self harm.  And  particularly what we’re seeing more recently are the ways in which political activists, journalists, medical professionals and others are being criminalised for speaking out and they’re actually called narrative terrorists by the Indian government. So that has a unique kind of set of mental health challenges as well.”

And care is either deliberately targeted or eroded over time due to the effects of militarisation, she added.

“In terms of, you know, who can access a hospital, what kinds of medications are available? Is there a curfew, is there a strike?”

Challenges faced by humanitarians 

WHO officials in northern Gaza mission in early March – attending to the physical needs of people trapped in conflict tends to overshadow mental health.

The complex of issues leaves humanitarian organisations with huge challenges in terms of how critical they choose to be about the underlying political or conflict dynamics while also trying to gain access to conflict settings where help is most needed. 

And even when services might be available, relief organisations must address stigma around getting care for mental health issues, Varma added.  

“There’s a lot of apprehension people have towards particularly biomedical Western medical psychiatric care that has to do with histories of abuse in psychiatric institutions.  It was only in 2001 that the Indian Supreme Court banned the use of restraints in psychiatric hospitals. So that’s very recent, and people remember those histories and that contributes a lot to their apprehension and seeking care.”

Finally, she said, humanitarian mental health care is inevitably limited in scope. 

“It’s not always able to provide health and mental health in the way in which local populations understand it. And in the case of Kashmir as with many other places in the world, people define health much more broadly than just being about the absence of symptoms. For them health has a social dimension, moral, spiritual, psychological and political. 

“I think the thing that I heard most often from people while I was doing my research was this idea that we will not be healthy until the conflict leaves us.”

At the same time, intervention strategies need to include more focus on the cultivation of positive survival skills, she said. 

“I think we need a lot more focus on the positive aspects of how people living in these contexts survive. So some of the things that I heard from people in Kashmir were for example, patience, cultivating patience, forbearance, hospitality, these are kind of critical coping skills that I think need a lot more attention…  So, all of those dimensions will also require attention from humanitarian organisation.” 

Countering stigma in Ukraine

Ukrainian child with his dog, displaced by war, in a refugee camp on the Moldova-Ukrainian border.

Ukraine, as well, also faces historical and cultural barriers to mental health care, with stigma persisting amidst a historical lack of resources, observed Dmytro Martsenkovsky, assistant professor at the  Department of Psychiatry of Bohomolets National Medical University, Kyiv. 

“Ukraine has inherited a Soviet-based type of mental health care, and it was very institutionalised,” he said. 

So basically, if people needed mental health services, hospitals were almost the only place people could access support, he said. 

But with civilians under heavy bombardment and confined to shelters, accessing hospitals became logistically more difficult, even as mental anxiety and related disorders grew exponentially. Moreover, more than 10 million people were displaced, saw family members killed, or experienced torture and imprisonment under various waves of Russian occupation.    

In addition, there is a lack of “mental health literacy” in Ukrainian society, with considerable stigma, he said.   

“It has some historical roots, but also a lot of people are afraid because, for them, seeking mental health services is showing that you’re weak, that you’re not able to cope with your conditions on your own,” Martsenkovsky said. 

Countering that, Ukraine’s First Lady, Olena Zelenska, has championed a more open approach to mental health treatment, supported by a broad-based mass media campaign. 

An online “How are You” platform has been developed that provides basic information on mental health and self-care techniques. 

“And this can help people who are feeling anxious or fear to seek professional care, to receive at least basic interventions to try to cope with their conditions,” he said. 

Martsenkovsky is also working with the Ministry of Health to provide more education to family doctors on basic mental health interventions. 

“And this is one of the core priorities because we had a lack of human resources even before the war,” but with the invasion most of the specialists, especially those who were women, were either displaced or left the country with their own children seeking safety and shelter.”

Recovery may take decades

Whether it’s Gaza, Ukraine or elsewhere, panellists all agreed that it typically takes “decades” for people to recover from the psychological trauma of war, particularly when the conflict also persists with no end in sight.  

“We are talking about … creating the possibility to enjoy life again, to have proper sleep, to not wake up from nightmares, to work for the prosperity of families and communities and to have a stable belief in a safe future,” Martsenkovsky said. “Because the longer the conflicts go on, fewer and fewer people are able to see a future for themselves and their children. It becomes more difficult for them to cope with everyday challenges.

“I’m not talking about the challenges of war, but about conflicts in families, financial difficulties that all of us face at points in time. And this will affect those who are traumatised by war for many decades … sometimes for generations.” 

Image Credits: © UNRWA/Ashraf Amra, People in Need, WHO , UNICEF/UN0599222/Moldovan.