Zero-emission vehicles powered by renewable energy could most likely avoid 1.9 million premature deaths, going up as much 2.4 million by 2040.

The International Council on Clean Transportation (ICCT), famous for busting Volkswagen’s Dieselgate, has a new ambition: Taking immediate action to shift to zero-emissions vehicles, significantly cutting ozone (O3) nitrogen dioxide (NO2) and PM2.5 pollution, and avoiding millions of cases of early death and paediatric asthma. Business-as-usual vehicle scenarios will lead to an increase. 

Because they breathe faster than adults, children are particularly vulnerable to emissions from vehicles. Toddlers are worse off because their shorter height means they’re closer to exhaust pipes. A new report has attempted to measure this and model various scenarios of controlling pollution from vehicles that would best protect children from asthma, and older people from air pollution-related chronic illnesses and premature deaths. 

The report, Global Health Benefits of Policies to Reduce On-Road Vehicle Pollution Through 2040, is by 10 authors, mostly associated with the ICCT. The group is perhaps best known for exposing Volkswagen for fudging on the true level of emissions from its popular diesel vehicles – known as the Dieselgate scandal. That cost the German auto giant billions of dollars and shifting producers away from the most health-harmful vehicle fuel. Now, the ICCT has turned its attention to the world’s vehicle fleet – analysing what would it take to reduce cases of early deaths and paediatric asthma over the next two decades. 

The authors say that their study, published in March as a Lancet pre-print, is the first of its kind to provide a globally consistent evaluation of this issue. They examined the impact of vehicular pollution at a one-kilometre resolution across 186 countries and territories that cover 99% of the global population. Fifteen emissions scenarios were evaluated representing different policy combinations. 

At one end is what the study calls the BASE scenario, where emission controls and policies analysed are as of March 2023, the time of this analysis. At the other end is the ALLZG scenario, the most ambitious one where all the best current and future technologies (like Euro 7 emission standard), are adopted for all sales of new internal combustion engines (ICE) in the world’s countries and territories. The ALLZG scenario also includes expedited rollout of zero-emission vehicles (ZEV), with renewable energy sources powering most of that shift. It further assumes countries would phase out older ICE vehicles, which don’t meet the most recent standards.  

Act to avoid premature deaths, children’s asthma

Children breathe faster and also are closer to the ground – thus more exposed to tailpipe emissions – ICCT.

Its conclusion is that the most ambitious ALLZG scenario could avoid 1.9 million premature deaths – and as many as 2.4 million between 2023 and 2040. People over the age of 65 would gain the biggest benefit in terms of avoided premature deaths. But in terms of illness, children would also benefit in a big way, especially in developing countries and urban areas. About 1.4 million cases of paediatric asthma could be avoided, with the projection rising to 1.7 million children – as many as half of them toddlers under the age of five. 

Under the business-as-usual scenario i.e. if government policies as of March 2023 remain in place, then annual deaths from transport-related emissions would increase from 182,000 annually in 2020 to 210,000 in 2040. Chronic obstructive pulmonary disease (COPD) or chronic lung disease, is the leading cause of air-pollution related premature deaths with cardiovascular disease, hypertension and cancer as other leading causes. 

Global South has the most to gain

Ozone concentrations are highest in African and Asian parts of the global south.

The study is preliminary and not peer-reviewed, the publishers point out. However, its data is broadly in line with trends and reality already observed especially about vehicular pollution.

Much of the Global South is way behind in controls. Many countries haven’t even implemented Euro 6, a diesel emission standard for vehicles first introduced in 2014 in the European Union, and a reference point for major manufacturers globally. It is also a truism that urban areas are more affected given the concentration of vehicles. Two-thirds of over 1.8 million new cases of paediatric asthma globally in 2019 occurred in urban areas. 

The report says that regions and trade blocs that mainly consist of countries in the Global South – Middle East, ASEAN (Southeast Asia), SAARC (South Asia), and ECOWAS (Africa) – have the greatest potential for mitigating new paediatric asthma cases from road transport emissions. Disparities in road transport-attributable health burdens are projected to widen amongst countries with different levels of development, with populations in countries with lower social demographic indices (SDIs) experiencing the largest increases in road transport-attributable health burdens. 

In countries without Euro 6 equivalent standards, implementing these could achieve 64% and 71% of the total benefits of all emission control measures combined for avoidable premature deaths and new paediatric asthma cases respectively. 

Most of the savings in lives from ozone (O3) would be in the global south, according to the analysis, published in preprint.

Overall, more than nine out of 10 fatalities are attributable to air pollution and the majority of the associated economic losses are concentrated in low-income and middle-income countries, and disproportionally affect children, the elderly, and socially vulnerable individuals.

One child’s death by vehicular pollution

Ella Roberta Adoo Kissi Debrah, who died on 15 February 2013 of a fatal asthma attack. She was the first air pollution victim to have that written as a cause on her death certificate, posthumously.

While the awareness about the links between air pollution and asthma has grown significantly, it has remained a more marginal issue in the air pollution debate, at least until the case of nine-year-old Ella Roberta Adoo Kissi Debrah who suffered from chronic asthma and died in 2013. Hers became the world’s first case where a death was officially attributed to air pollution. Initially, her death was merely attributed to acute respiratory failure. But  following a public campaign led by her mother, Rosamund Kissi-Debrah, a 2020 court ruling determined that her death should be attributed to levels of NO2 above the legal limits in her south-east London neighbourhood.

“The principal source of her exposure was traffic emissions.” The Coroner informed the court that “excess levels of nitrogen dioxide and particulate matter, PM10 and PM2.5, were a health risk, especially to children with asthma. Kissi-Debrah went on to found the Ella Roberta Foundation, campaigning against air pollution in the name of her late daughter. 

Still need an integrated approach 

Sadiq Khan, Mayor of London, has led a high-profile campaign to cut air pollution.

Bolstered by growing public awareness, London’s Mayor Sadiq Khan, who took office in 2016, has led a dramatic policy shift leading to sharp reductions in vehicular pollution. 

In March 2024, the mayor’s office announced that the roadside nitrogen dioxide (NO2) concentration levels had fallen by 49% between 2016 and 2023. NO2 levels were lower than even the first year of the COVID lockdown. The pandemic, moreover, vividly demonstrated to the public how a drastic reduction in traffic could reduce NO2, PM10, sulphur dioxide and carbon monoxide emissions, which are a direct or indirect result of burning fossil fuels for transport. 

As part of the shift, London has, of course, electrified vast chunks of its transport and tightened emission norms in lines with many of the recommendations of the new ICCT-led report.  However, the UK city also has created and expanded an ultra-low emission zone in the central city, greened public spaces, and created more cycling and pedestrian routes to encourage shifts to non-motorized transport along with improving public transport.

So while the London experience demonstrates that changes in vehicle emission policies can make a big difference, it also illustrates that an integrated approach remains critical – although the benefits of greener transport, mode shift, and greener urban planning remain to be quantified at a global level.

Not only that, but the climate impacts of reducing emissions also need to be considered along with the direct air quality benefits, as demonstrated in another report by ICCT, published late last year. That report focused on how reducing greenhouse gas emissions from vehicles could help limit global warming exceeding the 1.5° Celsius target climate scientists say needs to be reached to avoid greater catastrophic fallouts from extreme weather to the destruction of delicate coral reefs. Globally, road vehicles currently account for more than 20% of the carbon emissions from human activities, considering both fuel production and combustion. 

But both reports are clear.  To cut air pollutants from vehicles, policy action needs to be very ambitious and needs to start immediately, especially in the Global South. The Global North, as decades of climate negotiations have shown, needs to step up and transfer both green tech and money to the effort as fast as possible. Lives are at stake. 

Image Credits: Climateone.org , ICCT , ICCT , ICCT/The Lancet , Mayor of London .

CoViNet – The new network includes nearly 3 dozen research laboratories across the world with an expanded mandate.

The World Health Organization (WHO) has launched a new network, CoViNet, aimed at identifying, monitoring, and evaluating SARS-CoV-2, MERS-CoV, and emerging coronaviruses that pose significant public health risks.

The program expands on the WHO COVID-19 reference laboratory network, established in January 2020, in the early days of the pandemic.

Originally, the network’s primary goal was to offer confirmatory testing to countries lacking the capacity for testing SARS-CoV-2, including new variants. Over time, the requirements related to SARS-CoV-2 have changed. As such, CoViNet, with its “enhanced epidemiological and laboratory capacities,” according to WHO, will focus on tracking the virus’s evolution and the spread of variants and evaluating how these variants affect public health. The network brings together experts in animal health and environmental surveillance, other existing coronaviruses, and the identification of novel coronaviruses that could negatively affect human health. 

One Health focus 

The network will emphasize the significance of adopting a “OneHealth” strategy, the agency also added in a press release. The COVID-19 pandemic underscored the need for a comprehensive health approach that considers interactions among various species. The virus likely originated from a bat and was transmitted to humans through infected mammals kept and processed under unhygienic conditions at a market in Wuhan, China.

Finally, CoViNet will contribute to shaping WHO policies regarding public health and medical interventions. The data collected by CoViNet will inform the decisions of WHO’s Technical Advisory Groups on Viral Evolution and Vaccine Composition, among others. This will help ensure global health strategies and tools are grounded in the most up-to-date scientific insights.

“Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high-threat coronaviruses like SARS, MERS, and COVID-19 and to detect novel coronaviruses,” said Dr Maria Van Kerkhove, acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention. “This new global network for coronaviruses will ensure timely detection, monitoring, and assessment of coronaviruses of public health importance.”

So far, 36 laboratories from 21 countries are involved in the network – from FIOCRUZ in Brazil to Geneva University Hospitals, Institut Pasteur in Dakar, Senegal, and Pakistan’s National Institute of Health.  Representatives from the labs met last week in Geneva to finalize an action plan for the next 12 months.

WHO has reported 6,932,591 coronavirus deaths and 766,440,796 cases since the pandemic began – although the real number of deaths worldwide is presumed to have been far higher. The pandemic was declared over last year, while the number of people dying from the disease has declined since the Omicron variant first detected in the fall of 2021 in southern Africa became dominant.  But WHO has continued to encourage countries to report weekly aggregate indicators of COVID-19 morbidity and mortality and variant surveillance data, warning that new variants of the virus, or other related emerging viruses could still pose a global health risk. 

Image Credits: WHO .

Al Shifa Hospital’s Surgery wing Monday April 1, 2024 after Israeli forces withdrew from the compound.

Israel said Monday that its forces had withdrawn from Shifa Hospital, Gaza’s largest health facility, after two weeks of fierce fighting with Hamas gunmen barricaded inside that destroyed large parts of the facility, including the surgery, maternity and emergency wards.  

WHO Director General Tedros Adhanom Ghebreyesus said Sunday evening that some 21 patients had died during the fighting. Around 107 patients trapped in the compound had been moved multiple times, lacking adequate food, medicines and access to clean water and sanitation for basic hygiene and wound care, he stressed.  

He added that a mission to Gaza, originally scheduled for Saturday, had to be postponed and urged Israel to “facilitate a safe humanitarian corridor and a better deconfliction system for WHO and partners to support patient transfers. 

Israel re-entered Shifa in a surprise attack early Monday morning, 18 March, saying that key Hamas leaders had regrouped inside following Israel’s first raid on the hospital in November. 

Israel said it had killed some 400 Hamas operatives in the two week operation, including the heads of the organization’s rocket unit and supplies, as well as senior intelligence figures. It detained 900 more people, of which it said 500 were found to be affiliated with Hamas or its ally, Palestinian Islamic Jihad. The army also released footage of weapons caches seized in the raids, reportedly from patient beds, drop ceilings and walls, saying other “valuable intelligence” had also been recovered.   

The Hamas-controlled Health Ministry in Gaza said some 400 people had been killed at Shifa hospital, including a female doctor and her son. Following Israel’s withdrawal, WAFA, the official Palestinian Authority news agency, said “hundreds of bodies of slain civilians” were strewn on the hospital grounds. The hospital’s few remaining patients were being moved to Al Ahli Hospital about two kilometres to the south-east, Reuters reported. 

Over 6,000 people had been sheltering on the hospital grounds when Israel first entered the compound, those who were not killed or detained fled in the first days of fighting. 

Al Aqsa Hospital compound hit by another attack  

Further south in Gaza’s middle region, WHO’s Tedros said that Al-Aqsa Hospital had been hit Sunday by an Israeli airstrike while a WHO team was on a needs assessment mission there, including the collection of incubators to be sent to northern Gaza. 

Tedros said that four people were killed in the attack, which hit a tent camp inside the hospital compound. But the WHO mission officers were unharmed.  Israel said that it had launched “a precision strike” at an “operational Islamic Jihad command centre” positioned in the hospital courtyard. It said that the hospital building was undamaged. The BBC said, meanwhile, that seven journalists including one BBC freelancer, were amongst those injured in the Israeli strike that hit a group of makeshift tents on the hospital grounds.   

Al-Aqsa Hospital is the only hospital located in the middle area of the Gaza Strip in Deir al-Balah and was founded in 2001. As of 2018, this hospital is one of 15 public hospitals in the Gaza Strip and is managed by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).

“We again call for protection of patients, health personnel and humanitarian missions. The ongoing attacks and militarisation of hospitals must stop. International humanitarian law must be respected,” Tedros said.

The fact that Israel decided to re-occupy Shifa reflects the success of Hamas regrouping in Gaza City, despite Israel’s ostensible control of the area since late last year, experts on the conflict have observed. 

Northern Gaza has been cut off militarily by Israel from southern Gaza for weeks during the fighting, complicating aid deliveries to the area from the southern part of the strip, including the border town of Rafah, while the grinding conflict continues over the month of Ramadan. Negotiations over an Israeli-Hamas ceasefire, including the release of some of the 100 Israeli hostages still held in Gaza, have progressed only in fits and starts.

UN agencies have sounded repeated warnings of increasing hunger and risks of famine, particularly in the north where food aid deliveries are perilous. Scenes of people being killed by food parcels parachuted from the sky or shot or run over by aid trucks further underline the chaos surrounding the logistics of aid delivery. 

The International Court of Justice last week ordered Israel to allow unimpeded access of food aid to Gaza, saying that “famine is setting in.” Israel has said that it will no longer cooperate with the UNRWA personnel in aid deliveries due to UNRWA’s alleged complicity in the Hamas 7 October attacks on Israel, complicating the logistics of food deliveries.  

Meanwhile, WHO and other international relief agencies face an uphill challenge in maintaining basic functionality, let alone rebuilding, Gaza’s damaged health system, while fierce fighting continues and the threat of an invasion of Rafah looms. Only nine out of 36 Gaza hospitals continue to function, and most of those are concentrated in the southern or middle part of the enclave.  They are complemented by several emergency field hospitals, set up and run by international donors, also in the south.   

INB co-chairs Roland Driece and Precious Matsoso.

The fractious pandemic agreement talks – supposed to end with an agreement on Thursday (28 March) – have limped into extra time, with World Health Organization (WHO) member states resolving to hold an additional intergovernmental negotiating body (INB) meeting from 29 April to 10 May.

The World Health Assembly (WHA), which begins on 27 May, is supposed to adopt the agreement, intended to be a global guide on how to prevent, prepare for, and respond to, pandemics.

But the best case scenario is for the WHA to adopt an “instrument of essentials”, a bare-bones text that will be fleshed out over the next 12 to 24 months in advance of the proposed Conference of Parties, according to people close to the talks.

At the briefing at the end of Thursday’s talks, which started almost four hours later than scheduled, INB co-chair Roland Driece said that “there is no champagne”.

“We had long intensive discussions, but we have not succeeded in concluding this meeting,” added Driece. 

Consensus text

Instead, the INB Bureau would get a revised text to member states by no later than 18 April.

However, this text would be different from the previous one as it would aim to draw out consensus points rather than provide a shopping list of issues.

“That text will be building on the current one but also be different in focus and in level of detail, like we discussed before, but still trying to operationalise equity as much as we can,” said Driece. “We will build on the consensus already identified. Consensus is an important word.”

Extract from the INB 9 reportback

The INB drafting group will focus on “agreeing text”, and member states were also urged to “provide the Bureau with any convergence text resulting from informal consultations, as soon as possible”.

Meanwhile, when the INB resumes, there will be space for “structured informal meetings or working groups, as needed, to progress the work”.

At the start of the two-week negotiations, a number of member states had complained that their proposals and agreements reached in sub-groups had not been reflected in the Bureau’s draft text.

The focus on consensus appeared to cheer delegates, including Switzerland which said there was “a clear way forward”. Switzerland had refused to accept the draft text at the start of the talks.

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus implored delegates to draw on the “spirit of Geneva” to conclude the talks.

“Let the spirit of Geneva – the spirit of cooperation, mutual respect, and shared responsibility – guide your deliberations as you work towards finalising the agreement by the set deadline in May this year,” said a visibly tired Tedros.

“Together let us reaffirm our commitment to global health security, to solidarity in times of crisis and to a future where no one is left behind by operationalising equity with international law,” added Tedros.

WHO Director General Dr Tedros, flanked by WHO head of health emergencies, Dr Mike Ryan, at INB 9.

Putting on a brave face?

Finding consensus points may be hard in the coming days as many countries appear to have lost patience with one another, and with the INB Bureau and WHO Secretariat members who have been steering the process.

Countries across the political spectrum accused one another of refusing to make compromises, and criticised the Bureau for failing to provide direction.

However, the geopolitical reality is that some of the 194 member states are at war, while others are long-term trade enemies. This was never going to be easy, despite the recent trauma of COVID-19.

In the past two weeks, so much text has been added to the 31-page draft that the meeting started with that it had swollen to a completely unwieldy 100-page draft by Tuesday 26 March with multiple opposing clauses contained in brackets.

For example, by last Saturday (23 March), 50 countries had submitted at least one bracketed suggestion for Article 11, which deals with technology transfer, according to Knowledge Ecology International (KEI), which had two observers at the meeting.

However, the now notorious Article 12, which deals with pathogen access and benefit-sharing (PABS), remains the biggest obstacle.

The European Union believes that there is a place for intellectual property rights in PABS. However, this has been rejected by the Group on Equity – an alliance of 34 countries  – and the Africa region.

But the Group on Equity, which includes countries with large generic medicine producers such as India, Brazil and Indonesia, has also been accused of trying to secure advantages for these companies but taking a hard line on technology transfer.

Meanwhile, Colombia blamed the lack of progress in the past two weeks on “changing modalities, which were sometimes unclear, but also because we’re facing a highly complex document”.

“We support the Bureau in producing a streamline text and one which can achieve consensus but it will have to have substantive provisions which will take us beyond the status quo. The agreement that we will reach must be clearly based on the principles of equity and solidarity that tragic experiences that we live through during the COVID 19 pandemic.

Additional reporting by Elaine Ruth Fletcher

Farmworker Sonali Kadam has been finding it difficult to work in the fields during the summers because of unbearable pain caused by kidney stones.

Whenever farmworker Sonali Kadam experiences pain in her lower abdomen, she fears losing consciousness and pops a painkiller. 

Her fearful response goes back a decade when she was diagnosed with nephrolithiasis, commonly known as kidney stones, which are hard deposits of salt and minerals formed in the kidneys. 

When Kadam, a farmworker, first experienced this pain, she ignored it and kept working in the sugarcane fields. Within an hour, her pain aggravated, and she collapsed. 

Kadam, a resident of Arjunwad village in India’s Maharashtra state, has multiple stones in the kidney, each around 8mm in size. Usually, stones smaller than 5mm pass on their own through urine, while bigger stones might need medical intervention and sometimes even surgery.

In her quest to get rid of these stones, Kadam has consulted over 10 different doctors and took hundreds of painkillers but nothing worked. 

“This has traumatized me so much that whenever it starts paining, I fear I will either faint or die,” she told Health Policy Watch.

Kadam, 34, says her condition worsens in summers when the temperature tops 40° Celsius. As a farmworker, her day in the fields begins at 9am. There she sows seeds, clears weeds and harvests crops until about 5.30pm each day. 

“During this time, I am exposed to a lot of heat, which has been worsening my kidney stones,” she shares

Kidney disease rises with temperature

What Kadam has experienced isn’t a one-off case. Higher temperatures cause dehydration, leading to a rising concentration of minerals like calcium in the urine, which is responsible for the growth of kidney stones. 

A study published in the Lancet in March 2024 analyzed 135,4675 Acute Kidney Injury (AKI) cases in England between 2017 and 2021 and found a 62.3% increased odds of AKI when temperatures reached 32°C compared with that at 17°C. The researchers also found that in July 2021, a week-long heatwave led to a 28.6% increase in AKI counts. 

A study by the Children’s Hospital of Philadelphia in 2014 analyzed over 60,000 US patients and found a rising probability of people being diagnosed with kidney stones as daily temperatures rose. Researchers found that, at 30° C, the relative risk of kidney stone presentation was 36-39% higher than at 10° C.

Research from Australia points out that even a 1°C rise in daily minimum temperature increased emergency department admissions for kidney stones. 

Meanwhile, a paper in Nature’s Scientific Reports in January 2022 projecting the impact of rising heat on kidney stones in South Carolina, predicts that by 2089, even in the case of aggressive reduction in greenhouse gas emissions, the prevalence of kidney stones will increase by between 2.2% and 3.9%, costing an additional $57 million to $99 million respectively..  

According to the Global Burden of Disease study, 116 million cases of acute urolithiasis, a condition in which kidney stones move into the ureters, urethra, and bladder from the renal pelvis, occurred in 2019. 

This led to 13,300 deaths and 604,000 global disability-adjusted life years. For every 100,000 people, 1,394 were diagnosed with acute kidney stones. While there are no global projections yet, a rising chorus of experts are warning that kidney stones will rise sharply with the soaring temperatures.

“Global warming from climate change predisposes to kidney stones and acute kidney injury,” says Dr Matthew Borg, one of the authors and a biostatistician and research epidemiologist at t the University of Adelaide in Australia

Climate change can disrupt water treatment processes due to increased pollutant loads in heavy rainfall, which can decrease the availability of clean drinking water. 

“This can increase the risk of diarrhoeal diseases such as leptospirosis and schistosomiasis that, if not adequately managed, can cause dehydration and AKI,” Borg explains. 

There is already a 12% average prevalence of kidney stones worldwide, with 15% being the norm in Northern India. 

Unable to afford surgery 

Last year was the warmest year on the planet, during which India witnessed some of its deadliest heat waves. 

A report by international climate scientists found that human-induced climate change made the April 2023 heatwaves 30 times more likely in India and Bangladesh.  

Moreover, a paper published in PLOS Climate in 2023 found that heat waves can impact over 90% of India. 

Doctors have advised Vandana Badame to have surgery to remove her kidney stones, but she can’t afford it.

Three years ago, farmworker Vandana Badame felt a cramping pain in her side and back while working in the chilli fields in Maharashtra’s Ganeshwadi village. 

“The pain was unbearable. I kept puking and thought I was going to die,” 40-year-old Badame remembers. 

The culprit was a 9mm kidney stone. The doctors suggested surgery but she simply can’t afford it.

 Since then, she has relied solely on drinking water, hoping that the stone will pass through urine. But the kidney stone has caused her tremendous pain, which increases when she works in scorching heat. 

During such times, her only solution is to immediately go to a nearby clinic, take pain management injections, and continue working in the field. 

“Even if it pains, I have to keep working. What else can I do?” asks Badame, who is her family’s sole earner. 

Every month, she relies on intravenous drips to continue working in the fields. She gets 220 Indian Rupees ($2.65) for eight hours in the field, while an intravenous drip costs her at least Rs600 ($7). 

Whenever she steps out in the field, she carries five litres of water and painkillers. As the temperature increases, so does her vulnerability to the pain caused by kidney stones. 

A 2013 paper published in the International Journal of Environmental Health Research found that “the number of hot days in a year is positively correlated with the number of urolith patients”.

 Researchers also found that drought and semi-arid conditions in India made groundwater more saline, which is associated with the formation of kidney stones. 

Moreover, a 2020 study that analyzed 1500 industrial workers from South India exposed to extreme heat had a 2.3 times higher chance of severe health outcomes, with one third of steelworkers reporting kidney stones.

Lack of health facilities 

When farmworker Basappa Kamble, 51, collapsed from kidney stone pain at 1am in 2022, it took over an hour for him to reach the hospital. 

“There are no sonography facilities in the nearby areas,” says community healthcare worker Shubhangi Kamble, who rushed him to a private hospital where a 17 mm kidney stone was detected.  

“He was hospitalized for a week,” says Kamble. Despite the surgery, he complains of recurring pain. 

In his village, Arjunwad, with less than 6000 people, a majority are farmers, farm workers, and outdoor workers exposed to tremendous heat. 

Kamble started surveying her community and found that the problem of kidney stones peaked during summers. 

Workplace guidelines

“Workplace guidelines, such as enforced work to rest ratios, reducing physically strenuous work during the hottest hours of the day, and adequate access to good ventilation and shade, should be reviewed to improve workers’ safety in hot temperatures,” suggests Borge.

Besides this, he suggests general precautions like preparing for increased presentations of kidney stones and AKI, including staffing, equipment, training, and dialysis facilities during hot seasons.

However, for its 833 million strong rural population, India just has 764 district and 1224 sub-district hospitals catering to kidney ailments. 

“Since these hospitals are overcrowded and far away from villages, the only solution for many is to take a painkiller. Its overdose has led to several side effects,” shares Kamble. 

Farmworkers are forced to rely on costly private hospitals during such pressing times and a single doctor’s visit costs at least $6. Kadam and Badame earn this money after toiling in the fields for 16 hours. 

“Many times, I avoid going to the doctor and buy medicines from the pharmacy directly,” shares Kadam. 

Frustrated with the unbearable pain, sometimes she even ties a rope around her waist, attaches it to a firm object or a hook in the wall, and pushes herself against it. 

“This comforts me for a while. Every day, I feel like there is no end to this pain, and it will only go after I die.”

Image Credits: Sanket Jain.

Young children in Harare scrounge for left-over food.

HARARE, Zimbabwe – The maize meal porridge that their mother had previously blended with peanut butter and sugar for them is now a thing of the past for scrawny 13-year-old Nesbit Chigariro and his three siblings.

The family barely has enough food for a single meal a day, as the El Nino-induced drought sweeping southern Africa has pushed them to the wobbly edge of survival.

Miranda Chigariro, Nesbit’s 33-year-old mother, told Health Policy Watch that her children had fallen sick all at once earlier this year and nurses at a local clinic told her that they all suffered from kwashiorkor, a severe form of malnutrition.

The Chigariro family lives in Caledonia, an informal settlement 17 km east of the Zimbabwean capital, Harare. Harare is  home to nearly two million people, many battling starvation as a result of the latest drought.

Regional crisis

Many parts of southern Africa are contending with intense food shortages following the drought that has devastated crops during the region’s peak agricultural season from October 2023 to March 2024. 

The UN’s Food and Agriculture Organization (FAO) predicts that 33 African countries, including Zimbabwe and Zambia, will require outside help to address food insecurity.

“Many parts of Southern Africa are abnormally dry, with drought in eastern Angola, western and central Zambia, northeastern Namibia, northern Botswana, much of Zimbabwe, central Mozambique, central and eastern South Africa, and Lesotho,” according to the latest report (22-28 March) from the Famine Early Warning System (FEWS)

The El Nino phenomenon is triggered by the warming of the Pacific Ocean off the coast of South America, resulting in much less rainfall across many African countries and excessive rainfall in other parts of the world.

The governments of neighbouring Malawi and Zambia have already declared states of emergency because of drought and the Zimbabwean government is also believed to be contemplating this.

The drought has also reduced people’s access to clean water, causing cholera outbreaks. By mid-March 2024, a total of 28,556 cholera cases had been reported and 589 deaths from 62 districts across the 10 provinces, according to the United Nation’s children’s agency, UNICEF.

Some measured portions of maize meal on a vendor’s makeshift table in Harare, Zimbabwe. Times are desperate and many people are forced to buy tiny food portions.

Insufficient aid

In January, the United States Agency for International Development (USAID) announced a contribution of $11.27 million to the World Food Program (WFP) in Zimbabwe aimed at food aid for approximately 230,000 of the most vulnerable people across the hardest-hit districts, including Mwenezi, Mangwe, Chivi and Buhera.

This was supplemented by a $1.36 million contribution to the WFP by the Japanese government in February.

But this is a drop in the ocean as around a quarter of the population – 4.1 million Zimbabweans – teeter on the brink of food insecurity.

Amongst these millions are Nesbit and his three siblings, aged 10, six, and one, each facing the gnawing ache of hunger every day.

Nesbit’s parents sell sweets and popcorn on the streets in central Harare. If the siblings are lucky, they may get plain and unsweetened maize meal porridge once in a while.

The children are emaciated with jutting-out bellies that show their malnourished state.

Worst off is Nesbit’s one- year-old sister, who was weaned early because her mother, Miranda, could no longer produce adequate breast milk to feed her owing to hunger.

Miranda blames the drought for the family’s predicament, explaining that she and her husband rarely had enough to feed their children, let alone themselves.

“Our field, from which we have often harvested some maize each year, has produced nothing for us this time around, while very few people are buying from us these days as we sell our wares in the city,” Miranda told Health Policy Watch.

Looking thin and frail, Miranda said the family had been bashed by hunger that had worsened in the past three months.

Her malnourished husband, 37-year-old Dickson Chigariro, said that they only eat once at dinner time when they return home to their children.

A result of perpetual starvation and stress, Dickson and Miranda both suffer from stomach ulcers.

Inflation fuels hunger

A destitute blind beggar and her child on a street of Harare waits for Good Samaritans to donate anything to her.

With the cost of food ever rising, Zimbabwe’s inflation rate stands out at over 1,000%, the highest in the world, according to Professor Steve Hanke, a US economist at Johns Hopkins University.

In 1992, another drought killed over a million cattle in this country and many malnourished people turned to donors to help them survive.

But even as many Zimbabweans both in urban and rural areas are suffering, the government has remained adamant that nobody will succumb to hunger.

“Cabinet wishes to assure the nation that there will be enough grain before the commencement of the next maize or traditional grains intake in April 2024,” Zimbabwe’s Information Minister, Jenfan Muswere, told reporters last month after a Cabinet meeting. 

Not long after Muswere made the claims about food self-sufficiency, Zimbabwe received a donation of 25,000 tonnes of wheat and 23,000 tonnes of fertiliser from Russia.

Zimbabwe’s Agriculture Minister, Anxious Masuka, has also been on record in the media claiming that the southern African nation holds 190,000 metric tonnes of maize in its grain silos.

Yet with many Zimbabweans like the Chigariro family enduring hunger, government officials have played hide-and-seek games with the media, evading questions about the mounting hunger-related ailments.

“Thanks for your questions. However, the Ministry of Public Service and Social Welfare is most appropriate,”Donald Mujiri, a spokesman in the Ministry of Health, said in an emailed response to Health Policy Watch.

‘Nobody talks about it’

Malory Chagwiza, a trained nurse who volunteers as a community health worker because he cannot find work, said that the drought had also meant people were short of drinking water, which was causing dehydration.”

“Food insecurity is leading to malnutrition, which has negatively impacted the majority of people’s immune systems, rendering them susceptible to diseases. Some are already dying from the underlying effects of hunger, with nobody talking about it,” claimed Chagwiza.

Heatwaves and lack of water are also causing food-borne diseases as a result of food vendors operating under unhygienic conditions, he added.

Zimbabwe has also seen a surge in cholera cases, usually caused by people’s lack of access to clean water.

While the Zimbabwean authorities are indecisive about whether to declare the drought a state of disaster, there is grim evidence of this disaster in the country’s starving population.

“We can only endure, resting in the comfort that there are many like us here, some of whom are even worse,” said Miranda, from her disintegrating shack.

As Health Policy Watch, left she held a small bottle filled only with water to her one-year-old’s mouth. 

Image Credits: Jeffrey Moyo.

Women over the age of 60 and women with disabilities, face a higher risk of abuse yet their experiences are largely hidden in most data, according to two new publications released today by the World Health Organization (WHO).

Where there is data, these groups face high prevalence, with one systematic review finding greater risks of intimate partner violence for women with disabilities and another finding higher rates of sexual violence. 

“Older women and women with disabilities are under-represented in much of the available research on violence against women, which undermines the ability of programmes to meet their particular needs,” said Dr Lynnmarie Sardinha, Technical Officer at WHO and the UN Special Programme on Human Reproduction (HRP) for Violence against Women Data and Measurement.

Sardinha is one of the authors of two new WHO briefs on measuring violence against older women and against women with disabilities. These briefs are the first in a series on neglected forms of violence by the UN Women-WHO Joint Programme on Violence against Women Data. 

“Understanding how diverse women and girls are differently affected, and if and how they are accessing services, is critical to ending violence in all its forms,” said Sardinha.

According to the WHO, one in three women worldwide experience physical and/or sexual violence in their lifetime, whether from their intimate partners or from others. The prevalence of violence ranges from 20% in the WHO’s Western Pacific region, to 22% in Europe, and as high as 31- 33% in the Africa, Eastern Mediterranean and South-East Asia regions.

Additional risks

But older women and women with disabilities also face specific risks and additional forms of abuse, sometimes at the hands of caregivers or health care professionals. These include coercive and controlling behaviours such as withholding of medicines, assistive devices or other aspects of care, and financial abuse.

In older age, intimate partner violence tends to change from physical to psychological abuse, including threats of abandonment, although more research is needed to understand how power dynamics shift in older age.

Older women and women with disabilities can be extremely isolated when violence occurs, making it more difficult for them to escape and report the abuse. Stigma and discrimination can further reduce access to services or information, or result in their accounts of violence being dismissed by responders.

“Gender-based violence is rooted in unequal power and control over women,” said Dr Avni Amin, Head of the Rights and Equality across the Life Course Unit at WHO and HRP. 

“For older women and women with disabilities, their dependency and isolation are further exploited by perpetrators, increasing their risk of abuse. Services must be responsive to their needs and identify appropriate contacts through the health and care systems, so that all women experiencing violence can access empathetic, survivor-centered care.”

Noting that older women are currently represented in only about 10% of data on violence against women, the WHO recommends extending the age limit for survey participation and incorporating questions relating to different types of violence, encompassing a broad spectrum of disabilities.

They also advocate for user-friendly formats such as Braille or EasyRead to enhance the accessibility and participation of some disabled women.

Image Credits: UN Women.

Bats captured from the Kitaka mine in Uganda were discovered to be the source of a Marburg virus outbreak in July 2007.

As World Health Organization (WHO) member states bang heads in Geneva over a pandemic agreement to keep the world safe, a group of scientists has challenged global decision-makers to pay far more attention to humans’ relationship with animals.

“Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations,” write the 24 scientists from a range of different global institutions in an article in Nature Communications published on Tuesday (26 March).

Using bats as their case study, they show how environmental changes exacerbate zoonotic spillover – and identify the “ecological interventions that can disrupt these spillover mechanisms”.

Primary prevention of zoonotic spillover

Their ecological countermeasures focus on bats because a number of major epidemics and pandemics” – SARS-CoV-2, Ebola, SARS-CoV-1, MERS-CoV, and Nipah virus –  have an evolutionary origin in bats.

Certain bat species also host four of the nine diseases identified by the WHO as having the potential to generate epidemics that pose a great risk to public health.

So what does an ecological approach look like when applied to bats? The authors propose three measures to prevent zoonotic spillover from bats to humans.

The first involves protecting where bats eat, which involves numerous interventions including preserving and restoring vegetation diversity and structural complexity in bat foraging habitats.

In subtropical Australia, for example, Pteropus species bats (which carry the deadly Hendra virus) feed on nectar in winter-flowering forests. But in some areas, over 90% of these forests have been destroyed.

“Replanting winter habitats would be a sustainable, scalable, and effective strategy to reduce the risk of spillover of not just Hendra virus, but other viruses carried by Pteropus species bats,” they argue.

Preventing zoonotic spillover involves protecting bats where they eat and roost and protecting people wo interact with them.

The second measure involves protecting where bats roost.

“Roosts are locations where bats sleep, shelter, mate, socialise, and raise their young. With few exceptions, bats cannot construct shelters and must roost in pre-existing natural (eg, caves, rock crevices, tree cavities, and tree foliage) or human-made (eg, buildings, bridges, mines) structures,” the authors state.

The third measure involves protecting people and their livestock who come into contact with bats. This can be done by reducing livestock’s interactions with bats and bat excreta and providing personal protective equipment for peoplein contact with bats or their excreta.

In Malaysia, for example, “a regulation requiring fruit trees to be planted at a distance from pig sties may explain the lack of subsequent Nipah virus spillovers”, the authors note.

Integrating ecological and biomedical approaches

“Recognising that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy,” they argue.

Pandemics almost always start with a microbe infecting a wild animal in a natural environment, but when a wild animal then infects a human, this is often triggered by “human-caused land-use change”. The more land use changes, the greater the risk of zoonotic spillover.

“Designing land management and conservation strategies to explicitly limit spillover is central to meeting the challenge of pandemic prevention at a global scale,” they argue.

“In our view, the most effective strategy to reduce the probability of another pandemic is to preserve intact ecosystems and bolster their resilience through restoration and the creation of buffer zones.

“Our primary emphasis should be on maintaining and enhancing the integrity and resilience of still-intact landscapes to prevent new interfaces that could enable the emergence of Disease X.”

Pandemic agreement and One Health

Article 5 of the draft pandemic agreement is devoted to One Health, which it defines as “an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) is closely linked and interdependent”.

According to the draft agreement, parties will commit to a One Health approach for pandemic prevention, preparedness and response that is “coherent, comprehensive, integrated, coordinated and collaborative among relevant actors and sectors”.

Proposed measures include engaging communities to prevent, detect and respond to zoonotic outbreaks; workforce training; updating international standards and guidelines, and developing multilateral mechanisms to help developing countries to adopt a One Health approach.

Image Credits: Chris Black/WHO.

A convention of the Polish Left party, one of leading advocates for legalizing abortion.

Poland’s right-wing Law and Justice (PiS) party, which championed the country’s restrictive abortion laws, was voted out of power last October, but the path to improving access to abortion is not fast or straight forward.

“First of all, we need accessible abortions and we need, which is extremely important, the decriminalisation of abortion support,” activist Agata Adamczuk told Health Policy Watch. She is from Dziewuchy Dziewuchom (Gals Help Gals) Foundation, a Polish feminist NGO providing information on safe abortions. 

Yet, Parliamentary Speaker Szymon Hołownia says it’s not a good time to introduce abortion reform, the Polish Press Agency reports. According to Hołownia, parliamentarians may vote against any abortion reforms if they are placed on the agenda before the local government elections on 7 April, fearing reactions of more conservative voters.

“If we proceed after the [local] elections, the chances will be much greater. Talks and declarations about supporting the draft bills in the first reading will start,” said Hołownia, adding that discussion on a draft abortion reform Bill was set down for 11 April.

Coalition politics

Hołownia is leader of Polska 2050, a new Christian Democrat party,  and one of the three parties that make up the ruling coalition. The group is ambiguous in their stance towards reproductive rights, whereas the other two parties in ruling coalition, the New Left and Prime Minister Donald Tusk’s Civic Platform, have made abortion on demand up to the 12th week of pregnancy one of their priorities.

“It’s a good first step, in the right direction, but it’s not enough,” Adamczuk highlighted.

Even if there is a law granting abortion on demand until the 12th week of pregnancy, in practice it likely won’t be respected “because we’ve already faced such situations”, she adds.

Last year, demonstrations were held in 60 cities in protest against the unnecessary deaths of women because hospitals were reluctant to abort pregnancies that endangered their lives, even though performing them would have been legal, Newsweek Poland reported.

However, the Civic Platform and the New Left remain optimistic that abortion rights are a necessary and realistic goal for the current term of the parliament.

“We have the right to and we want the draft bill on abortion to be finally proceeded in the Sejm,” said Anna Maria Żukowska, a leader of the New Left, during the party’s summit.

Yet a new Bill to make abortion access less restrictive is likely to face opposition of some parties in the Catholic country, including the possibility that President Andrzej Duda, who is aligned to PiS, may veto it. He has been quoted as saying that advocating abortion access is “demanding the right to kill”.

Abortion mostly forbidden – but still happening

Poland’s abortion laws are the second most restrictive in Europe, with only Malta reaching a lower score on legality and accessibility, according to the Abortion Policies Atlas.

A comparison of abortion-related policies in Europe. Poland with considerably more restrictive laws than most countries.

Performing the procedure is now legal only in cases of rape and where there is serious risk to the mother’s health. Even then, doctors are permitted conscientious objection to performing abortions, which further limits access to abortion.

In 2020, the politicised Constitutional Tribunal ruled that it was against the Polish Constitution to allow abortion if there was a serious deformation of the foetus.

As a result of this ruling, the number of legal abortions decreased tenfold, amounting to only about a hundred cases per year since 2020, according to Statista.

Yet the total annual number of abortions is estimated to be between 80,000 and 93,000. Numerous NGOs help provide information and organisational support for ordering abortion pills online or assisting women to schedule a surgical abortion abroad.

Lack of education 

Women’s protests following the Constitutional Tribunal’s ruling are credited with helping to unseat the PiS party in the last parliamentary elections. The ruling coalition has made abortion on demand until the 12th week of pregnancy one of their top priorities.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions.

Even if the relaxation of abortion laws happens, it will do little to improve reproductive rights in Poland, according to Adamczuk. 

“Politicians should acknowledge the fact that simply changing the law will not automatically mean changing the situation for abortion accessibility. We need a more holistic revolution there,” she said.

“What we need is to do work at the ground level, to fight abortion stigma,” she stresses, pointing out that Polish medical circles are reluctant to provide abortion. 

The recent Polish Gynaecologists Association guidelines, for instance, say all other options should be tried before performing the procedure on a patient whose mental health is likely to suffer if they give birth.

Another crucial element is medical education: right now, no classes on abortion care are included in the gynaecologists’ curricula, Adamczuk says. 

Some sources highlight the causal link between the lack of education and the lack of accessibility. 

“If doctors receive the message that abortion is not a normal medical procedure during their studies, they will be more likely to carry on that opinion,” the activist added. “Performing abortions is almost exclusively our burden, of us activists, and most probably that won’t change in the nearest future.”

Decriminalising help

“We simply cannot be penalised for doing the job of the state,” Adamczuk highlighted, pointing out that decriminalising abortion help is one of the most urgent changes that need to happen. 

Last year, Polish abortion activist Justyna Wydrzyńska was found guilty of facilitating abortion and sentenced to eight months of community service. 

Although she declared that the court’s decision won’t stop her from continuing her work, such cases may have had a chilling effect on abortion access.

However, Wydrzyńska’s trial might have inspired another draft Bill currently waiting to be proceeded on decriminalising abortion support. 

The New Left has also proposed other Bills to advance women’s rights, including a change to the definition of rape and more favourable rules for maternity leave.

“We’re glad that abortion is the talk of the town right now, that there’s discussion about it,” says Adamczuk. “But just discussing is far too little.”

Image Credits: Lewica, Abortion Policies Atlas, Greenpeace Polska.

UN Security Council approves a first-ever resolution calling for a cease-fire in Gaza

WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday welcomed a UN Security Council resolution calling for a ceasefire and the assurance of humanitarian aid in Gaza, and the immediate release of all hostages. 

The resolution, which passed with a vote of 14 in favor and the United States abstaining, was the first resolution to pass the body since the 7 October attack by Hamas-led gunmen on Israeli communities that left 1,200 Israelis dead, and triggered Israel’s massive invasion of Gaza in a war that so far has resulted in the deaths of over 32,000 Palestinians, according to Gaza’s Hamas-run health ministry.  

Fighting continues in Shifa and raging around two more Gaza hospitals

Gaza’s Al Shifa hospital during a WHO visit on Friday 1 March – was only just getting back into service after months of siege, officials say.

The director-general’s comments came as fierce fighting continued to rage in and around three strategically placed Gazan hospitals – Al Shifa in the north, and Nasser and Al Amal Hospitals in Khan Younis. 

Israel claims to have killed over 170 Hamas militants in battles at Shifa over the past week, including Hamas chief of internal security, Faiq Mabhouh, along with detaining around 800 people on the hospital grounds. 

Hamas and Islamic Jihad gunmen continued to barricade themselves inside parts of the facility Monday night, Israel said.  The claims were denied by Hamas, which said that over a dozen patients had died during the operation, the most prolonged in a health facility since the war began.   

Patients and health workers who managed to leave the compound described harrowing scenes, with a shortage of food and water, and bodies piling up on the hospital grounds. 

Dr. Tayseer al-Tanna, 54, a vascular surgeon, told the New York Times that Israeli forces had gathered doctors and patients together in parts of the hospital, while they swept the grounds outside.

“The Israeli military didn’t treat us violently,” Dr. Al-Tanna was quoted as saying. “But we had almost no food and water.”   

He declined to comment on whether Palestinian fighters had fortified themselves in parts of the medical complex.

On Monday evening, Israel’s military spokesman claimed that Hamas and Islamic Jihad forces were still positioned inside the hospital’s emergency room, the maternity ward and a burn ward, were firing at Israeli forces, and throwing mortar shells from their positions.  

Following its first incursion into the hospital in November, Israel exposed video footage of Israeli hostages being brought into Shifa on 7 October. It also displayed caches of arms, ammunition and a tunnel dug underneath the compound. But experts later disputed the army’s claims that the hospital had been a major Hamas command and control centre.  On Monday, 17 March, Israel said that it had moved back into the hospital during an overnight operation, after it discovered leading Hamas military operatives regrouping there.

The hospital was only just getting back into service after weeks of siege in northern Gaza, in which medical supply deliveries were largely blocked, said Rick Peeperkorn speaking at a WHO press conference last Thursday.

“Shifa hospital was bouncing back and providing minimal services,” he said. But then a planned WHO mission to the hospital last week was cancelled by Israel. 

“It was cancelled due to the ongoing insecurity in the region. And this is, again, I think we’ve raised so often, what is needed is an effective and a transparent, workable deconfliction mechanism,” Peeperkorn said. 

The northern Gaza area is desperately in need of emergency malnutrition measures to stave off looming famine, he assserted. Hospitals also need to play a key role in this, he said, acting as “nutrition stabilisation centres” while northern Gaza, the area most at risk, is flooded “with ready-to-use therapeutic foods,” followed by a return to local food production as soon as possible.

Al Amal and Nasser Hospitals also now under siege 

Meanwhile, two other hospitals in the southern Gaza city of Khan Younis, Al Amal and Al Nasser, also came under siege by Israeli troops over the weekend, as fierce fighting raged in surrounding neighbourhoods.   

In separate statements, both Hamas officials in Gaza and the Palestinian Authority in the West Bank claimed that Israel had launched assaults on the hospitals, resulting in a number of casualties. Israel denied its forces had entered the hospitals, but said they had been cordoned off during fighting in the area.  

“@WHO and @ochaopt are extremely worried about the safety of the patients, companions, and the few health workers remaining at the hospital. We urgently need safe access to ensure patients can be provided with life-saving care,” stated an X post by WHO’s Office for the Occupied Palestinian Territories. 

“Our team was not given clearance to proceed to the hospital for assessment and facilitating patient transfer this evening but was able to assist nine health workers who walked from Al-Amal to south #Gaza with water and first aid.

“International law is clear: patients, health workers, and civilians must be protected. We urge parties to the conflict to respect their obligations.”

Image Credits: UN News , WHO.