Dr Olivi Ondchintia Putilala Silalahi, WHO Indonesia national professional officer for routine immunization, inspects a COVID-19 vaccination site in Indonesia.

A spike in COVID-19 cases in Southeast Asia has prompted Indonesia, Singapore and Malaysia to reintroduce screening for travellers at airports.

In the past week, Indonesia has installed thermal body scanners at Jakarta International Airport and the main ferry line.

The Bali Port Health Office has also implemented thermal checks at three border entry points: Benoa Port, Celuk Bawang, and I Gusti Ngurah Rai International Airport, and appealed to travellers to wear masks – particularly if they are feeling unwell.

Should a tourist or foreign national test positive for COVID-19 upon arrival, they will be immediately quarantined in a designated health facility or referral hospital in Bali, according to a circular issued this week by the Ministry of Health.

The Indonesian health authorities have also urged citizens to wear masks, ensure they are fully vaccinated and postpone travel to areas that are reporting a spike in COVID-19 cases.

https://twitter.com/BloombergAU/status/1735242493136920598

Jump in cases in Singapore

In Singapore, COVID cases increased by 10,000 in a single week, jumping from 22,000 to 32,035 in the week ended 2 December, according to the health ministry.

“The increase in cases could be due to a number of factors, including waning population immunity and increased travel and community interactions during the year-end travel and festive season,” said the Ministry of Health. 

“We urge the public to exercise precaution, personal and social responsibility,” said the Singaporean Health Ministry.

“When travelling overseas, stay vigilant and adopt relevant travel precautions, such as wearing a mask at the airport, purchasing travel insurance, and avoiding crowded areas with poor ventilation.”

“Everyone is advised to keep up to date with their COVID-19 vaccinations. This includes an additional dose around one year after their last vaccine dose for those aged 60 years and above, medically vulnerable persons, and residents of aged care facilities,” it added.

Malaysia COVID cases: 14 December 2023

Meanwhile, cases in Malaysia doubled in a week, jumping from 6,796 cases at the end of November to nearly 13,000 by 9 December, according to the New Strait Times.

Malaysian Health Minister Dzulkefly Ahmad recommended on Thursday that people wear masks and get a COVID-19 booster if they were elderly or had co-morbidities, according to the Strait Times.

Image Credits: WHO Indonesia.

The COP28 climate summit, the largest in history, concluded with a landmark but contentious agreement to transition away from fossil fuels, endorsed by 198 nations. This historic agreement, known as the UAE Consensus, represents the first time in the 28-year history of UN climate summits that nations have collectively resolved to move away from the fossil fuels that are at the heart of the climate crisis.

The final agreement calls for a “just, orderly, and equitable” transition away from fossil fuels in energy systems to achieve “net zero by 2050 in keeping with the science”. A call for a complete “phase-out” of fossil fuels was left out of the final agreement after intense lobbying from oil-producing countries led by Saudi Arabia, despite strong support for the phase-out wording from 127 nations, representing over 72% of the nations attending the climate summit.

“To those who opposed a clear reference to phase out of fossil fuels during the COP28: Whether you like it or not, fossil fuel phase-out is inevitable,” United Nations (UN) Secretary-General Antonio Guterres said on Wednesday. “Let’s hope it doesn’t come too late.” 

The final agreement notably restricts the call for a fossil fuel transition to “energy systems”, raising questions over the agreement’s applicability to fossil fuels used in heavy industry, as feedstocks for chemicals and plastics, and in transportation — all major contributors to annual greenhouse gas emissions.

Dr. Sultan Al Jaber, the summit’s president, lauded the agreement as a “historic” triumph of “unity, solidarity, and collaboration.”

“Together, we have confronted realities and we have set the world in the right direction,” said Al Jaber. “We have given it a robust action plan to keep 1.5 within reach. It is a plan that is led by the science.”

Reactions from scientists, activists, and policymakers were mixed, with many highlighting both the deal’s historic nature and its shortcomings.

“The deal is historic, no doubt. The final text signals the beginning of the end of the fossil fuel era,” Dr Maria Neira, head of the Department of Climate, Environment and Health at the World Health Organization (WHO) told Health Policy Watch.

“However, as fossil fuels are the leading driver of climate change and its health impacts, responsible for seven million premature deaths every year, and many other additional health hazards, a rapid and ambitious phase-out will be critical for health,” Neira added.  

Language in the UAE Consensus limiting the transition away from fossil fuels to “energy systems” has raised concerns about the scope of global commitments to reduce dependence on fossil fuels in other sectors. / Data: IEA

Dr Friederike Otto, a prominent climate scientist from Imperial College London and a founding member of the World Weather Attribution group, expressed profound disappointment with the outcomes of the COP28 agreement.

 “The lukewarm agreement reached at COP28 will cost every country, no matter how rich, no matter how poor. Everyone loses. With every vague verb, every empty promise in the final text, millions more people will enter the frontline of climate change and many will die,” said Otto.  

“It’s hailed as a compromise, but we need to be very clear what has been compromised. The short-term financial interest of a few has again won over the health, lives and livelihoods of most people living on this planet,” she added. 

Small island states, already grappling with the existential threats of rising sea levels and intensifying storms, epitomize this sense of sacrifice and imminent danger on the frontlines of climate change. Delegates from these imperilled island nations characterized the absence of a complete fossil fuel phase-out in the final agreement as a “death sentence” for their homelands.

“We have built a canoe with a weak and leaky hull. Yet we have to put it into the water because we have no other option,” a representative from the Marshall Islands told the closing plenary of the summit. “We need to phase out fossil fuels. It’s a small step in the right direction. In the context of the real world, it is not enough.”

‘A historic COP’

The agreement, nonetheless, is groundbreaking. It recommits the world to the 1.5°C warming target of the 2015 Paris Agreement, a goal reiterated 13 times in the text, and clearly states that the science dictates countries must cut emissions by 43% by 2030, and 60% by 2035 relative to 2019 levels.

It also commits to reaching net zero carbon dioxide emissions by 2050, calls for a tripling of global renewable energy capacity, and slashing methane emissions. 

The agreement also candidly addresses the immense scale of the financial challenges ahead. It estimates that developing countries will require between $215-billion and $387 billion in adaptation finance by 2030, with a global annual investment of $4.3 trillion in green energy required until 2030, escalating to $5 trillion thereafter. 

The agreement also includes a call for reforming the global financial architecture, notably the World Bank and the International Monetary Fund, to enable developing countries to access vital finance to adapt to climate change. 

“We got a loss and damage fund. We got the recapitalisation of the Green Climate Fund for adaptation. We got an affirmation of a climate finance system, which runs from public finance to private finance. We got a commitment to the tripling of renewables and we got an affirmation of transitioning away from fossil fuels,” Avinash Persaud, Special Envoy to Barbados Prime Minister Mia Mottley, said in a media briefing on Wednesday. 

“Those are five difficult things,” he added. “It’s a historic COP, the best we’ve had in eight years (since Paris).” 

Further accomplishments of the UAE Consensus include pledges to halt deforestation by 2030 and to incorporate health as a distinct sector in adaptation funding, a key ask of the World Health Organization and global health experts. 

“Health is firmly embedded in the newly adopted Global Goal on Adaptation,” Arthur Wyns, COP28 advisor at the WHO, told Health Policy Watch. “A dedicated health adaptation target helps to ensure the health sector itself will receive a stronger focus on adaptation going forward.”

‘A litany of loopholes’

Global greenhouse gas emissions has steadily increased year-on-year since the first UN Climate Summit in 1995.

Despite these advancements, the agreement’s non-binding nature and “litany of loopholes” elucidated by the Alliance of Small Island States have raised significant concerns about its implementation and whether it will mark a true turning point in the climate crisis.

The final agreement contains a series of concessions to fossil fuel interests, including references to “transition fuels” — code for natural gas — and carbon capture and storage technologies, which remain unproven on a large scale. An estimated 79% of operating carbon capture capacity globally is used to reinject captured carbon into the ground to produce more oil. These technologies also incur significant costs and frequently result in net increases in emissions. 

A timeline for the complete phase-out of methane emissions – a potent but short-lived greenhouse gas – and language calling for a peak in global greenhouse gas emissions by 2025, were removed from the final agreement.

Global standards for regulating carbon markets, a key issue given the prevailing skepticism about the legitimacy of carbon markets as a means to offset emissions, remained unestablished due to opposition spearheaded by Saudi Arabia, China, and India.

These loopholes leave considerable room for interpretation and potential exploitation by vested interests, Simon Stiell, President of the UN Framework Convention on Climate Change (UNFCCC) said in his closing remarks on Wednesday. 

“Loopholes leave us vulnerable to fossil fuel vested interests, which could crash our ability to protect people everywhere against rising climate impacts,” Stiell remarked in his closing comments. “Transparency and people holding their governments to account will be vital to closing these loopholes.”

“Whilst we didn’t turn the page on the fossil fuel era in Dubai, this outcome is the beginning of the end,” said Stiell. “Now all governments and businesses need to turn these pledges into real-economy outcomes, without delay.”

Climate finance question remains unanswered

Climate finance from rich countries fell to $21 billion in 2021, hundreds of billions short of the estimated financial needs of developing countries every year for adaptation alone.

While the agreement recognizes the need for trillions, not billions, of dollars to tackle climate change,  it stops short of outlining specific funding sources. The more than $85 billion mobilized in new climate finance at COP28 is significant but falls far short of what is required for developing countries to transition equitably to green energy. The United States, the world’s largest economy, committed a mere $20 million in new climate funds at the summit.

Madeline Diouff Sarr, chair of the Least Developed Countries Group representing nearly 50 of the world’s poorest nations, expressed disappointment in the agreement, describing it as “the very lowest possible ambition we could accept.”

“There is recognition in this text of the trillions of dollars needed to address climate change in our countries. Yet it fails to deliver a credible response to this challenge. Next year will be critical in deciding the new climate finance goal,” said Sarr. “Today’s outcome is full of eloquent language but regrettably devoid of actionable commitments.”

While COP28 marked a day-one victory for climate finance by operationalizing the Loss and Damage Fund, which aims to provide financial assistance to vulnerable countries in the path of the most devastating effects of climate change, the fund is effectively empty so will do little to bridge the climate finance gap in the short-term.

“Limiting warming to 1.5°C is a matter of survival,” said Sarr. “[It] not only requires countries to urgently reduce domestic emissions but also the delivery of significant climate finance.”

Fossil fuel production paradox

Governments’ fossil fuel expansion plans show they intend to produce, in total, 110% more fossil fuels in 2030 than are compatible with the 1.5°C limit set out in the Paris Agreement, and 69% more than is consistent with 2°C of warming, according to UNEP.

The agreement also fails to address the paradox of ongoing global fossil fuel production expansion. Despite a clear mandate for drastic emission reductions by the decade’s end, there remains a significant gap between current efforts and those required to maintain the 1.5°C target.

Saudi Arabia and other oil and gas-producing states made headlines for their efforts to exclude fossil fuel language from the final agreement, but governments and industries worldwide continue to ramp up fossil fuel production, casting a shadow over the commitments made in Dubai.

Ursula von Der Leyen, President of the European Commission,  praised the Dubai agreement as “historic” and marking “the beginning of the post-fossil era,” yet European countries continue to spend billions on new liquified natural gas terminals as the continent diversifies away from Russian oil and gas and increase imports from the very African countries it is asking to limit use of these energy sources. 

The United States, which backed stronger language on eliminating fossil fuels, continues to lead the world in oil and gas production, which is at historic highs, and expand production. 

Adnoc is opening up new oil and gas fields in the United Arab Emirates and expanding its drilling sites off the coast of the Arabian Peninsula. 

Adnoc, the Abu Dhabi National Oil Company run by COP President Al Jaber, plans to invest over $150 billion over the next five years to expand production – the largest such plan by any company in the world. More than 92% of Adnoc’s oil and gas expansion plans are not compatible with the 1.5°C pathways, according to data from German environmental NGO Urgewalt. 

Despite the escalating climate crisis, 96% of oil and gas companies involved in exploration for new deposits continue to develop new oil and gas fields, according to the Global Oil and Gas Exit list, a database which tracks the activity of companies responsible for 95% of global oil and gas output.

“COP is meant to be the vehicle for solutions, but all it seems to do is recognise problems that the rest of the world identified years ago,” said Mike O’Sullivan, a leading climate expert from the University of Exeter. “It’s obvious to most people that limiting global warming meant reduced fossil fuel use, but only now do our leaders say this.

“But so what? Where are the real global plans for the energy transition, without relying on fanciful tech solutions, with adequate support for poorer nations? Where is the global leadership to take the right action, not the selfish action? Across the globe, there are plans to expand fossil production – how does this fit with the text that’s just been agreed?” said O’Sullivan. 

The market’s reaction to the COP28 pledge did not indicate concern for its potential impact on the fossil fuel sector. In fact, premarket trading saw a modest increase in the shares of oil giants Chevron and Exxon Mobil on Wednesday. 

In another sign of confidence in the sector, Aramco, the leading global oil producer, finalized an agreement on Tuesday to secure a 40% stake in Gas & Oil Pakistan, marking its inaugural venture into the Pakistani market and the latest chapter of the company’s global expansion. 

Mike Berners-Lee, a carbon footprinting specialist at Lancaster University, cautioned that the fossil fuel sector achieved its goals at the summit.

“Cop28 is the fossil fuel industry’s dream outcome,” he observed. “Because it looks like progress, but it isn’t.”

Image Credits: UNEP.

Rush hour traffic in Ho Chi Minh City in Vietnam.

Ten countries have slashed their road traffic deaths in half between 2010 and 2021, while  35 others have reduced deaths by between 30% and 50%, according to the World Health Organization’s (WHO) Global Status Report on Road Safety 2023 released this week.

The big achievers are Belarus, Brunei, Denmark, Japan, Lithuania, Norway, Russia, Trinidad and Tobago, United Arab Emirates and Venezuela.

Meanwhile, there was an overall global reduction in deaths of 5% over the period, with 1.19 million people dying per year.

“Yet with more than two deaths occurring per minute and over 3,200 per day, road traffic crashes remain the leading killer of children and youth aged 5–29 years,” according to the WHO.

“The tragic tally of road crash deaths is heading in the right direction, downwards, but nowhere near fast enough,” says WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “The carnage on our roads is preventable. We call on all countries to put people rather than cars at the centre of their transport systems, ensuring the safety of pedestrians, cyclists and other vulnerable road users.”

The majority of road traffic deaths occurred in the WHO’s South-East Asia Region (28%), followed by the Western Pacific (25%), African Region (19%), the Americas (12%), and the Eastern Mediterranean Region (11%). The least occurred in the European Region (5%).

Some 90% of deaths occur in low- and middle-income countries (LMICs), and the risk of death is three times higher in low-income than high-income countries despite low-income countries only having 1% of the world’s motor vehicles.

More than half of fatalities occur among pedestrians, cyclists and motorcyclists, in particular those living in LMICs. Pedestrian deaths rose 3% to 274,000 over the decade, accounting for 23% of global fatalities. Deaths among cyclists rose by nearly 20% to 71,000, accounting for 6% of global deaths. 

“Research indicates that 80% of the world’s roads fail to meet pedestrian safety standards and just 0.2% have cycle lanes, leaving these road users dangerously exposed. And while nine in 10 people surveyed identify as pedestrians, just a quarter of countries have policies to promote walking, cycling and public transport,” according to WHO.

The report also reveals an alarming lack of progress in advancing laws and safety standards. Only six countries have laws that meet WHO best practice for all risk factors, namely speeding, drunk driving, compulsory motorcycle helmets, seatbelts and child restraints.

The global motor vehicle fleet is set to double by 2030, but only 35 countries – less than a fifth of UN Member States – legislate on all key vehicle safety features, while only a quarter require vehicle safety inspections that cover all road users.

“Our mission at Bloomberg Philanthropies is to save and improve as many lives as possible, and one of the best ways to do that is to make more of the world’s roads safe for all,” said Michael R. Bloomberg, founder of  Bloomberg Philanthropies, which supports a substantial global road safety programme.

“For more than a decade now, we’ve made encouraging progress together with the WHO and our partners. Still, as this new report makes clear, road safety demands stronger commitments from governments worldwide – and we’ll continue to urge more leaders to take lifesaving action,” added Bloomberg, who is the WHO’s Global Ambassador for Noncommunicable Diseases and Injuries.

Image Credits: tph567/Flickr, Flickr/ M M.

The outsized effect of climate change on young children represents an “intergenerational injustice”, according to experts speaking at a side event on maternal and child health at COP28 in Dubai. 

“Nearly 90% of the global burden of disease associated with climate change is borne by children under the age of five,” according to UNICEF. 

“Climate change has already had an impact on heat-related child mortality in sub-Saharan Africa. The annual average heat-related child mortality for the period from 2005 to 2014 was approximately under 20% higher than would have been observed without climate change. This so-called ‘climate penalty’ will be worse over the coming years,” said Veronique Filippi, Professor at the London School of Hygiene and Tropical Medicine. 

There is also compelling evidence that heat can increase the risk of preterm births, stillbirths, hypertension as well as preeclampsia, she said.

“There are no physiological reasons why pregnant women or newborns are more vulnerable to the health impact of environmental disasters,” emphasized Filippi. “The main reason for vulnerability is the position of women in society, their limited agency and mobility.” 

Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organization (WHO) said that while global carbon emissions have to be reduced, health facilities also have to be equipped with solar power and cooling facilities for patients. 

“For every climate-related project proposal, we should make sure that it has a maternal, child, adolescent health impact lens as well,” he said. 

WHO’s Dr Anshu Banerjee.

Evidence gaps

While there is growing evidence of the different ways climate change affects pregnant women and young children, there continue to be gaps which affect the response.

“Most of the evidence is related to the effects of air pollution, followed by temperature and the effect of disasters, food insecurity, and water access,” Filippi said. 

Angela Baschieri, UNFPA’s Technical Lead on Climate Change, reiterated that it was important to generate “evidence that helps us to inform how we design program as well as the evidence that we need to ensure that we are targeting and we are reaching those who are left behind or may be more exposed”. 

Only 23 national climate action plans out of 119 reviewed by UNFPA have made some reference to maternal and newborn health. These responses have largely been community-led interventions, Baschieri said.
Improving basics like water and sanitation, as well as involving community healthcare workers emerged as some of the key responses that experts said are known to deliver results.

Improve basics like water access

Nobel Prize-winning economist Michael Kremer from the University of Chicago said ensuring communities have basics like clean drinking water can go a long way in responding to worsening climate impacts.

“First, cyclones, floods and heavy rains spread pathogens into drinking water sources causing disease spikes,” he said. “Second, droughts can force people to move to less safe water sources. Finally, increased temperatures can accelerate the growth of pathogens and water,” he explained, elaborating on the climate change and poor water quality link. 

Kremer said water treatment provides a proven safe and cost-effective solution and could prevent a quarter of children’s deaths.

“Water treatment can save more lives than virtually any other health intervention,” he said. Kremer pointed out gains countries like India, Rwanda and Malawi have policies and pilot projects to improve the delivery of safe drinking water to populations. 

“Water treatment has historically been neglected because it falls between the health sector and the water sector. And as many people emphasize, we need to move beyond the silos, particularly as climate change increases threats to water safety and health,” Kremer said.

Working with community-based health workers to improve healthcare delivery is a direct way to provide relief to pregnant women and children.

Nobel Prize-winning economist Michael Kremer

Community-based response

In 2022, when extreme rainfall worsened by climate change caused devastating floods in Pakistan,  over 100,000 pregnant women were affected, primarily because they could not access services.

“The breakdown that had happened in continuity of care led to so many adverse outcomes in maternal health,” said Neha Mankani, a midwife and project lead at the International Confederation of Midwives. 

“They did not have a safe place to give birth. There were abortion care services that they weren’t able to get, and there were newborn feeding issues that were happening,” she said, adding that community-based healthcare workers were a solution in times of crisis.

Neha Mankani, a midwife and a Project Lead at the International Confederation of Midwives

“We should look at climate change through a rights and human capital development lens and ensure that meaningful engagement of the most vulnerable. Women and children need to be engaged in setting policies because they are the ones who know how it affects them,” said Banerjee.

Image Credits: Guillaume de Germain/ Unsplash.

The UN climate negotiations have gone into overtime – again.

Early this week, the 28th year of United Nations (UN) climate summits saw its hopes for a historic agreement to end the fossil fuel era dashed by industry interests resisting efforts to phase out their use.

The negotiations extended into overtime, familiar to COP proceedings, as diplomats from nearly 200 countries attempted to bridge the global divide on the future of fossil fuels and prevent the summit’s collapse.

The fight over the final agreement intensified when a draft was released by the United Arab Emirates (UAE) presidency on Monday. It removed language explicitly calling for a total “phase out” of oil, gas, and coal from the global energy mix.

The latest draft text, released on Wednesday after negotiations pressed on into the early hours of the morning, does not include a commitment to phase out or down fossil fuels. Scientists, environmentalists, and human rights advocates say phasing out fossil fuels is essential to maintaining the 1.5C warming cap set in the 2015 Paris Agreement.

Instead, the draft calls on nations to transition “away from fossil fuels in energy systems, in a just, orderly, and equitable manner, accelerating action in this critical decade, so as to achieve net zero by 2050 in keeping with the science.”

Other significant changes include removing a directive to phase out coal use “this decade” and limits on new coal production, allowing coal-dependent nations like China and India to continue their reliance on the highly polluting fuel.

Specific targets for reducing methane and other non-greenhouse gas emissions were removed. Recognition of the “need for deep, rapid and sustained reductions in greenhouse gas emissions in line with the 1.5C pathways” was added for the first time.

‘False solutions’

“It is clear that not everyone is ready to admit the truth of what’s needed,” said Tom Evans, policy advisor at climate change think tank E3G. “This text alone might help avoid disaster in Dubai but it does not avoid disaster for the planet.”

While the first draft drew widespread criticism, reactions to the new draft are mixed. The central change in language around fossil fuels is the shift from nations “should” transition away from fossil fuels to a text that “calls on” nations to do so — a minor but significant change in U.N. language.

Over 120 countries, 72% of nations at COP, have expressed direct support for an agreement that includes phasing out fossil fuels, according to an analysis by the Pacific Islands Climate Action Network and Oil Change International on Tuesday. This marks a significant increase from COP27 in Egypt, when 80 countries called for a phase-out limited to the electricity sector.

“Overall, we get a clear signal to phase out fossil fuels… It is not the most ambitious outcome we could have landed at this COP, given the momentum from over a hundred countries demanding strong language on this, but it’s a step forward,” said Amos Wemanya, senior advisor at Renewable Energy and Just Transitions. “But we still have a lot of false solutions in the text.”

 

The mood after the first draft agreement on Monday was summarized by former US Vice President Al Gore, who criticized the draft for reading “as if OPEC [the Organization of Petroleum Exporting Countries] dictated it word for word.”

“COP28 is now on the verge of complete failure. The world desperately needs to phase out fossil fuels as quickly as possible,” Gore said. “There are 24 hours left to show whose side the world is on: the side that wants to protect humanity’s future by kickstarting the orderly phase-out of fossil fuels or the side of the petrostates and the leaders of the oil and gas companies fueling the historic climate catastrophe.”

Although the draft falls short of the “phase out” demands from more than 120 nations, environmental groups, and scientists, it is the first COP agreement to directly address the need to move away from all fossil fuels. This represents a significant shift in focus for the UN climate negotiations, which did not explicitly mention any fossil fuels until COP26 in Glasgow, where coal was first included.

“For the first time in three decades of climate negotiations the words fossil fuels have ever made it into a COP  outcome,” said Mohamed Adow, Director of the energy and climate think tank Power Shift Africa. “We are finally naming the elephant in the room.”

While the diagnosis of the climate crisis is accurately represented in the draft agreement, scientists note the solutions and actions presented fall far short of the action required to address the scale of the crisis the text describes. 

“There seems to be a total disconnect between the diagnosis and the treatment,” said Jean Pascale van Ypersele, professor of Environmental Sciences at the UC Louvain and former vice chair of the UN’s Intergovernmental Panel on Climate Change (IPCC).  “The diagnosis is that of a potentially deadly cancer, due to abuse of fossil fuels,” said van Ypersele. “The prescribed treatment is a mixture of wishful thinking and magic.” 

The current draft agreement’s sole mention of “health” as a human right, without explicitly addressing key health issues like air pollution, has disappointed global health experts following the apparent momentum generated by the inaugural Health Day at the UN climate summit.

“The difference for people’s health of phasing out only ‘unabated’ fossil fuels, versus a full fossil fuel phase-out is night and day,” said Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance. “Currently 99% of the world’s population breathes unhealthy air, with five million people per year dying prematurely due to the air pollution produced by the use of fossil fuels.”

“COP28’s only sane pathway – one that will protect people’s health – is an agreement that sets in motion the orderly and just phase out of all fossil fuels”, said Miller. 

‘We didn’t come here to sign our death sentence’ 

During a closed-door meeting at COP28 on Tuesday, as reported by The Guardian, sharp divisions emerged over the future of fossil fuels, highlighting the deep rifts that could derail an agreement crucial for the planet’s future.

Australia, representing a coalition of major fossil fuel consumers and producers including Canada, Chile, Norway, the European Union (EU), and the US, advocated for a decisive move away from these energy sources. The EU and US separately pressed for a firmer stance on fossil fuels in the final agreement.

“Overall it is clearly insufficient and not adequate to addressing the problem we’re here to address,” said EU climate commissioner Woepke Hoekstra. 

The US State Department demanded that the wording on fossil fuels be “substantially strengthened”.

Small island nations, facing immediate threats from sea level rise, see any agreement lacking a robust commitment to fossil fuel phase-out as a potential “death sentence”.

Joseph Sikulu, a climate activist from the Pacific island of Tonga, broke into tears at a press conference on Tuesday when asked about the stakes of the agreement for his and other island nations. 

“We didn’t come here to sign our death sentences and the text in its current state is that,” said Sikulu. “We know that our negotiators are in there, holding the line and they’re still fighting.” 

“In Paris, we fought for our lives for 1.5C and slowly we see it going away from our grasp every year,” added Sikulu. “[Negotiations] have now just become words.” 

John Silk, Minister of Natural Resources and Commerce for the Marshall Islands, echoed the desperate plea of small island states for their continued existence.

“We will not go silently to our watery graves,” said Silk. “We will not accept an outcome that will lead to the devastation for our country.” 

Finance disputes significant for developing nations

The debate over financing climate adaptation and green energy transitions in developing countries, which have not benefited from centuries of fossil fuel development, is as central to the final text disagreements as the phase-out language. Many developing nations view the phase-out demands from wealthy countries without accompanying funding as unfair, arguing that it fails to recognize their limited role in historical emissions.

“Rich countries say they want a global phase-out of fossil fuels, but they are refusing to fund it,” said Adow. “There is simply not enough in the current text for African countries to believe there will be finance to help them leapfrog dirty energy nor adapt to climate impacts.”

India also highlighted the omission of historical cumulative colonial emissions as a crucial oversight of the draft agreement, a criticism echoed by environmental groups and experts, who have singled out industrialized nations like the U.S., Canada, and Norway for their historical emissions and ongoing oil production expansion.

Governments Plan Massive Expansion of Fossil Fuel Production Despite Climate Crisis, UN Warns

“Many reports have clearly shown that these same countries, as they come here and pretend to be climate champions and talk about limiting temperature rise and talk about ending fossil fuels, have signed and continue to sign licenses for expansion and production of fossil fuels,” Meena Raman, of the Third World Network and a veteran of the COP process, said in reference to recent reports by the UN Environment Programme and Oil Change International. 

Governments and industry continue to expand fossil fuel production, with governments worldwide on track to produce fossil fuels at a rate 110% higher than the 1.5°C target by 2030. The top 20 oil and gas companies, meanwhile, are projected to emit 173% above the 1.5°C limit in 2040.

Raman also pointed out the draft’s failure to address the means of implementation which would allow developing countries to invest in green energy. These include can areas such as finance, technology, and capacity building, crucial for developing nations to phase out fossil fuels. 

Despite a day-one victory at COP28 to operationalize the Loss and Damage Fund, which aims to deliver financial assistance from developed nations to vulnerable countries coping with the escalating effects of climate change, the fund remains largely empty.

Demands for increased climate finance in the COP agreement, especially from the US, face domestic political hurdles, with a Republican-led Congress unwilling to allocate such funds. This standoff affects not just climate-related financing but also other areas of greater political consensus in the US, such as military aid to Ukraine.

Bangladesh, representing the 46 Least Developed Countries, expressed disappointment with the draft’s lack of a commitment to keeping global warming below 1.5C, labelling the text as weak and contradictory.

Cuba, on behalf of the G77+China group of 135 nations, argued in the meeting that the draft inadequately recognizes the primary responsibility of affluent countries in climate action and their obligation to support less wealthy nations.

China objected to including a 2025 global carbon emissions peak target in the agreement, citing the longer historical emissions of developed countries.

OPEC arrives at the party 

The complex geopolitics of oil-producing nations, especially Saudi Arabia’s role as the de facto leader of OPEC, are complicating COP28 talks. Reports from Dubai indicate that UAE’s COP28 President Sultan al-Jaber is under substantial pressure from Saudi Arabia to exclude any references to fossil fuels in the agreement. This stance is shared by other OPEC and OPEC+ members, including Iran, Iraq, and Russia. 

Al Jaber has so far resisted complying with these demands, stating on Tuesday “We must remain focused on our primary goal of keeping the 1.5C target within reach”.

Saudi pressure to eliminate any mention of fossil fuels from the final agreement follows a letter from OPEC Secretary-General Haitham Al Ghais that was leaked to The Guardian on Friday. The letter urged OPEC members to “proactively reject any text or formula that targets energy, i.e. fossil fuels, rather than emissions”.

Ghais stressed the urgent need to counter what he described as politically motivated campaigns threatening the prosperity of OPEC nations that would put “our people’s prosperity and future at risk.” 

Dan Marks, an energy security expert at the Royal United Services Institute (RUSI), explained to the Guardian that major oil producers, including Saudi Arabia, are cautious about policies aimed at reducing fossil fuel supply, due to significant national interests.

Saudi Arabia, holding nearly 300 billion barrels of oil, accounts for about one-fifth of the global oil reserves. As the unofficial leader of OPEC, which represents close to 80% of the world’s oil reserves, the kingdom plays a pivotal role in global oil dynamics.

“They have interests they need to protect,” said Marks, adding that proposals for phasing out fossil fuels could trigger instability in these oil-rich nations. 

Earlier in the year, OPEC criticized projections by the International Energy Agency (IEA) suggesting a peak in demand for fossil fuels such as coal, oil, and gas before 2030 as “overly hazardous” and “unworkable”. The oil cartel has also accused the IEA of “unjustly vilifying the [oil and gas] industry as being behind the climate crisis” as well as setting out a roadmap for the global energy system that will cause “energy chaos on a potentially unprecedented scale”.

“Clearly, there is an emerging proactive fossil coalition,” a senior EU negotiator close to the negotiations told the Financial Times after the new draft was released. “In the past, we had more silent resistance and now it seems more conscious and more focused and more co-ordinated.”

Negotiators in Dubai now face the daunting task of crafting a consensus-driven agreement that avoids outright rejection by any party. Veteran observers speculate that in the face of a potential deadlock, no agreement might be preferable. Countries desiring a robust deal are trapped between accepting a diluted agreement or none at all.

“It seems more or less impossible now to get a wording that clearly calls for the ‘phase out’ goal, as demanded by the small islands and the EU,” said Michael Jacobs, a COP veteran and professor of political economy at Sheffield University. “The OPEC states won’t agree to it, and the UAE (a member of OPEC) won’t insist on it from the chair.”

Jacobs pointed out that the summit’s most significant achievement, the establishment of the loss and damage fund, was already secured on the first day. “Even if the COP negotiations were to collapse now, this milestone wouldn’t be reversed,” he said.

“What would be lost are – sorry, but this is true – various forms of words which are not binding and won’t materially affect any countries’ immediate behaviour.” 

UN Secretary-General Antonio Guterres, who made a return trip to Dubai for the final stage of the talks earlier this week, underscored the urgency of the situation. 

“We need an ambitious outcome that demonstrates decisive climate action and a credible plan to keep the 1.5°C warming limit alive,” said Guterres. “[We must] protect those on the frontlines of the climate crisis.” 

Image Credits: Simon Evans.

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market prior to the outbreak of COVID-19, from top left: King rat snake, Chinese bamboo rat, Amur hedgehog, Raccoon dog, Marmot and Hog badger.

The powerful Group of 20 (G20) countries will host a high-level meeting on One Health in October 2024 to better prepare members to address the health of people, animals and ecosystems.

This was revealed by Alexandre Ghisleni, Brazil’s Global Health Ambassador, at a COP28 side event to launch an implementation guide for the One Health Joint Plan of Action devised by the four United Nations (UN) agencies.

Known as the quadripartite, the four are the Food and Agriculture Organization , UN Environment Programme (UNEP), World Health Organization (WHO) and World Organisation for Animal Health (WOAH).

“Brazil has been very supportive of the One Health approach,” said Ghisleni. “Evidence of this was the way we have handled the avian flu cases that we’ve had this year in our country.  It was only due to very close cooperation between the Ministries of Environment, Agriculture and Health, that Brazil was able to handle these cases satisfactorily.”

Brazil, which assumes the G20 presidency next year, will host the One Health meeting to “explore in detail and at length, all the aspects related to it so we can better face the challenges of our time”, he added. 

Alexandre Ghisleni, Brazil’s Global Health Ambassador

There has been heightened awareness about the need for a holistic approach to human, animal and environmental health since the deadly COVID-19 pandemic. Both SARS-CoV2, which caused COVID-19, and MERS-CoV originate in bats. Meanwhile, there is widespread speculation that the Huanan market in Wuhan, where wild animals were kept in unsanitary conditions, was the origin of the COVID pandemic.

Mpox and anthrax outbreaks, both originating in animals, have also surged over the past two years. There is growing awareness that countries need to contain zoonotic spillovers from animals to people, and One Health is featuring prominently in the current pandemic agreement negotiations being conducted under the auspices of the WHO.

Surging vector-borne diseases

On Tuesday, the European Food Safety Authority (EFSA) released a report on the most common zoonotic diseases in the European Union in 2022, noting that there had been a marked increase in West Nile virus, which is transmitted by mosquitoes.

“Climate change is increasing the surge of vector-borne diseases. That’s why today a One Health approach integrating human and animal risk assessments is the way forward” said Frank Verdonk, Head of EFSA’s Biological Hazards and Animal Health and Welfare unit.

The number of food-borne outbreaks in the EU increased by 44%, from 4,005 outbreaks in 2021 to 5,763 in 2022, associated with a wide variety of foods, ranging from meat and dairy products to fish and vegetables. 

Dr Ariane Hildebrandt, Director-General of Germany’s Ministry for Economic Cooperation and Development (BMZ)

Dr Ariane Hildebrandt, Director-General of Germany’s Ministry for Economic Cooperation and Development (BMZ), told the launch that a “multidisciplinary approach that considers the interconnection between health, climate and biodiversity is necessary” as,  “without a healthy environment, there cannot be health for human and animal life”. 

“We will continue to work towards the goal of reducing health risks in our partner countries, strengthening human and veterinary health systems, improving early warning systems, protecting biodiversity and thus contributing to epidemic and pandemic prevention,” she added.

The guide is an operational addition to the 2022 One Health Joint Plan of Action, and  outlines three pathways – governance, sectoral integration, and evidence and knowledge – and five steps to achieve One Health implementation.

“One of our main principles when developing the guide is to make it applicable to all countries, regardless of their status of One Health implementation, and acknowledges transdisciplinary and diversity of stakeholders.” Dr Amina Benyahia, WHO head of the One Health Initiative.

“The climate emergency has far-reaching consequences that threaten all life on earth. Direct factors like heat waves and floods as well as indirect factors like changes to disease spread due to changing weather patterns are just some of the risks to the health of animals, humans, and entire ecosystems,” said Doreen Robinson, the Head of Biodiversity and Land at UNEP.

Robinson added that an “early investment in inclusive and systemic One Health approaches ensures we’re tackling such interconnected, complex issues for a healthier, more resilient future for both people and planet.”

“Despite the growing awareness of the One Health approach in recent years, the world remains vulnerable to many global threats unless this approach is translated into policies and actions, and adequately and sustainably financed,” said Thanawat Tiensin, FAO’s director of Animal Production and Health Division.

At the first-ever health and climate day during COP28, 134 countries backed a Climate and Health Declaration to place health at the heart of climate action and accelerate the development of climate-resilient, sustainable and equitable health systems.

Image Credits: Nature .

New IFRC President Kate Forbes of the American Red Cross

GENEVA – The election of the next president of the International Federation of the Red Cross and Red Crescent Societies (IFRC) was almost derailed on Monday after the body’s board tried to postpone voting to investigate sexual harassment allegations against one of the candidates, Kenya’s Abbas Gullet.

However, Kate Forbes of the American Red Cross was eventually elected after the general assembly overruled the board and pushed ahead with the election.

There was an uproar from the Red Cross and Red Crescent societies after a last-minute announcement by IFRC’s outgoing president, Francesco Rocca, that the governing board had decided to postpone elections following sexual harassment allegations against Gullet, one of the four contenders for the top job.

The alleged acts were said to have taken place between 2016 and 2018, Rocca said. Gullet, who was secretary general of the Kenyan Red Cross from 2005 until 2020, has said he would welcome an investigation into the allegations.

Rocca, who at first didn’t disclose the name of Abbas or the nature of the allegations, told the general assembly that the board had decided to launch an investigation into claims received on 28 November.

“This decision was not made lightly but is necessary to ensure the integrity of the federation and the concerned candidate,” Rocca said, arguing that free and fair elections could not be held under the circumstances.

But the announcement displeased delegates in the room, triggering heated exchanges with Rocca. 

‘Slap in the face’

The Moroccan Red Crescent said it was a “slap in the face of the societies in Georgia, Egypt, the US and Kenya”, the national societies backing the various candidates, describing it as a “manoeuvre” by the board and the presidency.

Jordan’s national chapter also protested against the last-minute postponement and said it was up to the general assembly to decide, drawing applause from the room.

Addressing the elephant in the room, the Kenyan Red Cross told the assembly that its candidate was being targeted and proposed that elections go ahead and if elected, Gullet would step aside pending the investigation.

Gullet, who was invited by Rocca to take the floor, accused the board of “double standards”, referring to Rocca’s integrity being brought into question when he was a candidate in 2017 over the fact that he went to prison when he was 19 years old for dealing drugs, to which an irritated Rocca replied that he had addressed this openly with the general assembly at that time.

The elections to replace Rocca were already mired in controversy. Rocca announced in June he would step down from the position early following conflicts of interest after his election in March as president of the right-wing government of the Lazio region, encompassing Rome.

The IFRC general assembly overruled the body’s board.

After a row over the technicalities of whether the elections could go ahead or not, the governing board walked out of the room to reconsider the matter and decided it was finally up to the general assembly, given the level of disagreement with the board.

Rocca cautioned delegates that they would have to be ready to deal with the reputational fallout of having an elected president step aside during an investigation into sexual harassment allegations.

However, the overwhelming majority voted in favour of holding the elections. The Red Crosses of Switzerland, the United Kingdom, Denmark and Trinidad et Tobago were among the few outliers to vote against.

Forbes was finally elected with 88 votes in favour out of 163 national chapters that took part in the vote. Gullet received 75 votes. Natia Loladze, president of Georgia’s Red Cross and IFRC vice-president, was eliminated in the first round, only gathering 15 votes, and Egypt Red Crescent’s chief executive Ramy El Nazer, who amassed 22 votes, decided to withdraw from the race.

The investigation into the allegations against Gullet will still go ahead, given that he is a member of the IFRC’s Standing Committee.

Second female president

Forbes was, until now, the chairman of the IFRC’s Audit and Risk Commission. She’s been an American Red Cross volunteer for 43 years and has held various positions within the IFRC over the last 17 years.

During her presentation speech earlier in the morning, she said that, if elected she would only “serve one term so I can focus on the work and not on being re-elected”. 

She also said she had resigned from her other board positions and promised she would not run for political office.

Forbes, 72, from Phoenix, Arizona, is the second woman and the fifth American to hold the position in the federation’s 104 years of existence. She took over from Rocca as soon as the assembly closed.

In short remarks, Forbes said that in what had been a “strange day”, her message was of “unity” for the global movement.

Rocca closed the meeting, echoing Forbes’s call for unity and apologising for his own mistakes during his time as president.

This article was first published in Geneva Solutions.

 

Image Credits: IFRC.

DUBAI, United Arab Emirates – Black carbon is a super pollutant and its emissions are commonly seen anywhere you see black smoke – from a tiny kerosene lamp to a massive ship. The main sources include the burning of biomass, garbage dumps, diesel vehicles, coal-fired power plants, brick kilns, wood fires, wildfires and, on the high seas, ships.

Superpollutants are sometimes referred to as short-lived climate pollutants. Black carbon (BC) has a lifespan of just one or two weeks before it falls to the earth, in comparison to carbon dioxide which has a lifespan of a few hundred years in the atmosphere. 

But in this short span, its effects are devastating. Conversely, cutting its emissions can lead to rapid health and climate action benefits. 

Jane Burston is the CEO of Clean Air Fund (CAF), one of the four organisations that produced the report, The Case For Action On Black Carbon,  that was launched at COP28 over the weekend.

The other organisations were the Center for Study of Science, Technology, and Policy (CSTEP); Berkeley Air Monitoring Group, and Orbis Air.

She explains why, despite its short lifespan, BC’s global warming potential is as bad as carbon dioxide, the biggest contributor to climate change. 

“It’s black, so when it’s in the atmosphere, it radiates. It captures energy from the sunlight and radiates heat into the atmosphere. So even though it only stays in the atmosphere for up to a couple of weeks, it has a very high global warming potential. While it’s there, it’s as bad as a ton of carbon dioxide.”

Jane Burston, CEO of Clean Air Fund.

Threat to Polar Ice Caps, Himalayas, Andes 

While BC affects its immediate area the most, in the right conditions it can spread very far. It covers polar ice caps and glaciers in soot which in turn absorb more heat and trigger more melting. 

The retreat of the Himalayan glaciers has accelerated by 50% between 2012-14 because of BC warming and snow darkening, which in turn affects the monsoon. 

“It causes a different type of cloud formation and changes rainfall patterns. So we’ve seen black carbon in India changing monsoon rainfall pattern and in West Africa the Sahel similarly,” Burston told Health Policy Watch.

It’s not just Himalayan glaciers retreat that BC has been linked to, the report says it decreases Arctic sea-ice cover in summer, advances the western United States melting season, and increases run-off in the Andean glaciers.

Panel at COP28 on black carbon: (L-R) Dr Indu K Murthy, (CSTEP), Nina Renshaw (CAF), Michael Johnson (Berkeley Air Monitoring Group) and Paula García Holley (Clean Air Task Force).

Health impacts of black carbon

BC contributes to a significant chunk of PM 2.5, or particulate matter with a diameter of 2.5 microns or less which is microscopic. PM 2.5 is usually the most tracked air pollutant, according to the report. 

Annual deaths due to fine particulate and ozone air pollution are estimated to be 8.34 million, which is more than one in 10 deaths, according to a recent report in the BMJ. More than half (52%) of these deaths are due to heart attacks, strokes and pulmonary diseases including cancer. 

“The highest total attributable mortality occurs in China, with 2.44 million deaths per year, followed by India with 2.18 million deaths per year.” according to the BMJ, November, 2023.

BC is strongly correlated with increased blood pressure levels, a high-risk factor for cardiovascular disease and strokes. It affects pregnant women and has been linked to low birth weight. 

While it’s not clear exactly how many premature deaths are linked to black carbon, the report assumes two scenarios. If BC is assumed to be equally toxic as other PM 2.5 components then it is associated with 150,000 deaths worldwide. But if BC is “significantly” more toxic then widespread reduction of BC emissions has the potential to reduce premature mortality by as much as 400,000 annually over North India’s Indo-Gangetic Plain alone. 

Aerial view of a wildfire.

“I’ve been working on a study of household air pollution intervention that we’re proud of as it is the biggest randomised control trial looking at the health effects of transitioning from biomass stoves to clean cooking LPG,” said Michael Johnson, technical director of Berkeley Air Monitoring Group. “And we found the effects on birthweight to be more strongly linked with black carbon than with PM 2.5.”

Nina Renshaw, CAF’s head of health, has studied BC for two decades: “The thinking is that the black carbon within PM 2.5 may be actually more harmful than other components of PM 2.5. There’s still research to be done in that area. But what we do know is that black carbon is particularly damaging for cardiovascular health – heart attacks, disease, strokes, neurological damage, and so on. Black carbon has also proven to have an impact during pregnancy and birth outcomes, low birth weights and so on.”

‘No brainer’ – start cutting black carbon now 

The new report on black carbon fills a vacuum as there has been far less work on it than carbon dioxide, ozone and PM 2.5. There hasn’t been much global monitoring and there ought to be more studies on epidemiological evidence and toxicology for air quality regulations.

R Subramanian from the Center for Study of Science, Technology, and Policy (CSTEP)

R Subramanian, head of Air Quality at the Center for Study of Science, Technology, and Policy (CSTEP), Bengaluru, told Health Policy Watch: “As we are moving closer to the climate tipping points, we need more levers that we can control to avoid reaching those tipping points.” 

Renshaw says it’s a “no-brainer” to include cutting black carbon emissions as part of programmes to cut PM 2.5.

“Working on particulate matter, PM2.5 in particular, is a no-brainer. That is a WHO guideline, the International Agency on Cancer Research (IARC) says that this is carcinogenic and so on. We can begin to capture black carbon and do that. So let’s go down that route as an urgency and fill up the gaps as science allows.”

Indu K Murthy, CSTEP’s head of Climate, Environment, and Sustainability,  highlights another route, via government regulation: “We’re talking about cleaner energy and clean air which is a mandate of every government in any case. And you just have to kind of bundle it along with that till we get the metrics right.

Image Credits: Nick Sorockin/ Unsplash, Marc Szeglat/ Unsplash.

Anthrax of the skin, and anthrax bacteria.

Zambia is experiencing its worst anthrax outbreak in a decade, while four neighbouring countries – Kenya, Malawi, Uganda and Zimbabwe – have also reported outbreaks, according to the World Health Organization’s (WHO) Africa region.

By 20 November, four Zambians had died, with 684 suspected and 37 confirmed cases from nine of the country’s 10 provinces. Twenty-six people developed sores on their faces, arms, and fingers after eating the meat from three wild hippopotamus carcasses.

Beyond Zambia, a further 482 suspected cases have been identified, according to the WHO. Thirteen people have died in Uganda, three people have died in Kenya, and one in  Malawi. 

Anthrax is a zoonotic disease caused by a bacteria that occurs naturally in soil and mostly affects ruminants such as cows, sheep and goats. Humans develop the disease from infected animals or contaminated animal products, and almost always need to be hospitalised after infection as it causes serious illness.

People can start showing symptoms within hours or up to three weeks after exposure. By far the most common presentation is cutaneous (skin), with itchy bumps that rapidly develop into black sores. Some people then develop headaches, muscle aches, fever, and vomiting. These cases originate from people handling infected carcasses, hides, hair, meat or bones.

Gastrointestinal anthrax causes initial symptoms similar to food poisoning but can worsen to produce severe abdominal pain, vomiting of blood and severe diarrhoea.

Pulmonary anthrax is the most serious form, initially presenting as a common cold but can rapidly progress to severe breathing difficulties and shock. 

High risk of regional spread

“Due to the scale of the outbreak in Zambia, shared ecosystem with neighbouring countries and frequent cross-border animal and human movement, there is a heightened risk of regional spread of the disease,” according to WHO.

Anthrax cases are already spreading in areas along the basin of the Zambezi, Kafue, and Luangwa rivers.  Carcasses of wild animals that float on the rivers also increase the risk of international spread to neighbouring countries. 

“To end these outbreaks we must break the cycle of infection by first preventing the disease in animals. We are supporting the ongoing national outbreak control efforts by providing expertise as well as reinforcing collaboration with partner agencies for a common approach to safeguard human and animal health,” said Dr Matshidiso Moeti, WHO’s Africa Director. 

There is a vaccine for people and animals but there is limited stock, according to WHO. The Zambian government has vaccinated more than 122,000 cattle, sheep and goats with support from Food and Agricultural Organization (FAO).

A joint One Health task force comprising the Ministries of Health and Local Government has been conducting case finding in animals and humans. The country’s veterinary department is conducting meat inspections in abattoirs and butcher shops, while the Department of Wildlife and Parks is monitoring illegal animal movements and ensuring proper disposal of carcasses. 

“The outbreaks are likely being driven by multiple factors, including climatic shocks, food insecurity, low risk perception and exposure to the disease through handling the meat of infected animals,” according to the WHO.

Image Credits: Gavi.

WHO Executive Board meeting on the health and humanitarian situation in Gaza, Sunday

In a fragile show of unity, the World Health Organization Executive Board approved a draft resolution calling for “immediate, sustained and unimpeded” humanitarian relief to beleaguered Gaza, including safe passage of health personnel and supplies, as well as ambulances and patients. 

The WHO EB move, which will clear the resolution for approval by the May World Health Assembly, represents the first-ever consensus statement on the charged conflict so far in a UN body. The draft resolution  on “Health Conditions in the Occupied Palestinian Territory” carefully sidesteps any direct references either to Hamas or Israel in a charged conflict where both Israeli and Palestinian leaders, and their allies, have accused each other of genocide and war crimes. 

Sunday’s approval of the WHO EB resolution came just two days after another UN Security Council resolution calling for a humanitarian cease-fire in Gaza was vetoed by the United States because it did not condemn the initial Hamas 7 October attack on Israeli communities, which led to the deaths of some 1,200 people, mostly civilians, and the taking of more than 240 Israeli hostages. 

US deputy ambassador Robert Wood had called Friday’s UN resolution “imbalanced”, saying that a cease fire that left Hamas in power in Gaza would “only plant the seeds for the next war.” 

The WHO EB resolution, in contrast, focusses on humanitarian relief, making only one reference in the preamble to the broader UN “appeal for a humanitarian cease-fire.” Along with general calls for the free flow of aid and relief to besieged Palestinians, it also mandates WHO to lay plans for the rebuilding of Gaza’s shattered health system.

Operative paragraphs of the draft WHA resolution approved by the WHO EB on Sunday

Tedros: It is still possible to find common ground

“I commend you …. for being willing to collaborate and compromise … In our fractured and divided world it is still possible to find common ground on even the most difficult issues,” said Dr Tedros Adhanom Ghebreyesus at the close of the extraordinary day-long EB session. 

“Of course the adoption of this resolution is only a starting point. It doesn’t not resolve the crisis, but it’s a platform on which to build,” Tedros stated. 

Breaking with its own precedent in the UN Security Council, the US supported the resolution,  co-sponsored by Yemen, Morocco and Afghanistan – albeit with “reservations”.

Those reservations, said the US, also backed by fellow EB member Canada, included the omission from the text of references to the Hamas 7 October incursions, Hamas hostage taking, and its use of hospitals and civilians as shields for military activities – as well as the preamble reference to UN calls for an immediate cease-fire.

Convening an EB meeting devoted to a single health and humanitarian crisis was unprecedented in the annals of WHO. Although a resolution denouncing Russia’s invasion of Ukraine was approved by WHO’s World Health Assembly in 2022, it was addressed in the health assembly’s regular session, as were follow-up reports and motions in the February 2023 WHO EB meeting, and the May 2023 WHA session.

Gaza health system is ‘on its knees’ 

Gaza health system overview presented by WHO’s Dr Teresa Zakaria at the special EB meeting, 10 December 2023

In the debate just prior to Sunday’s EB vote, senior WHO officials provided a detailed report of the current health and humanitarian situation in Gaza, including a first-hand report from Gaza City.  

“More than 17,000 people are reported to have died in Gaza, including 7,000 children and we don’t know how many are buried under the rubble of their homes,” said Dr Tedros, in a summary of the WHO findings.

“More than 46,000 injuries have been reported. 1.9 million people have been displaced. Almost the entire population of the Gaza Strip is looking for shelter anywhere they can find it but nowhere and no one is safe in Gaza,” Tedros said.

Fighting between Israel and Gaza’s Hamas regime resumed on 1 December after the breakdown of Qatar- and Egyptian-mediated talks over further release of the 137 Israeli hostages still held by Hamas against Palestinian prisoners in Israeli jails and detention centres, estimated at some 7,000 people – a number that has swelled since the conflict began. 

The seven-day humanitarian cease-fire in late November saw the release of some 114 hostages, mostly Israeli women and children but also including 24 Thai and Filipino nationals, in exchange for some 240 Palestinians released from Israeli prisons. Many of the released Palestinian prisoners were also women and teenage minors, including some who had been detained but not charged. 

Nowhere to flee

View of Gaza destruction from the seat of a UN vehicle

The renewed fighting has seen a new Israeli thrust into Hamas strongholds deep in southern Gaza, where most of the enclave’s 2 million people fled during the first phase of hostilities, and are now living in tents, schools and on the streets. 

“As more and more people move to a smaller and smaller area, overcrowding combined with the lack of adequate food, water, shelter and adaptation are creating the ideal conditions  for diseases to spread,” Tedros said.

“As I have said repeatedly, I deplore the barbaric and unjustifiable attacks by Hamas on Israel on the seventh of October, which killed more than 1,200 people. 

“I’m appalled by reports of gender based violence during the attacks and by the mistreatment of hostages,” added the WHO director general, with reference to Israeli claims that women killed or kidnapped by Hamas on 7 October were raped and sexually abused.

“And I repeat my call for the remaining hostages to be released. I will understand the anger, grief and fear of the Israeli people following the horrific attacks two months ago,” he continued. 

“I also understand the anger grief and fear of the people of Gaza who had already suffered through 16 years of blockade and are now enduring the destruction of their families, their homes, their communities, and the life they knew. 

“It’s stating the obvious to say that the impact of the conflict on health is catastrophic. The Gaza health system is on its knees and collapsing.”

Gaza casualties still rising

Gaza fatalities continue to rise

While the majority of Israel’s 1,297 casualties were incurred during the initial Hamas attacks on Israeli communities on 7 October, within Gaza “the trend of fatalities continues to rise, placing a tremendous burden on the already weakened health system,” said Teresa Zakaria, WHO Health Emergencies official, reporting on the casualty trends.  

“The largest proportion of fatalities recorded were amongst children, 45%, and women, 30%,” Zakaria added, referring to the Hamas breakdown of Palestinian casualties. “The number of children killed in the three weeks following 7 October, surpassed the annual number of children killed in [all] conflict zones since 2019, she asserted, citing a recent Save the Children, report. 

There have also been over 250 fatalities amongst Palestinians in the Israeli-occupied West Bank, and 94 fatalities in Lebanon as the conflict spills over regionally, Zakaria noted. 

Hospital functionality and humanitarian aid

Overview of Gaza hospital bed capacity as of 9 December 2023

Against the flood of injuries, only 14 of Gaza’s 36 hospitals are still operating, and that only partially, Zakaria said.  Of those, 12 hospitals are in the southern part of the enclave, where most people have fled. Only three have surgical capacities, while other aspects of functionality are limited by lack of fuel supplies, food and clean water.  In addition several field hospitals are operating, under the auspices of foreign donors. 

According to Tedros, there have been a reported 449 attacks on health facilities in Gaza and the West Bank and another 60 attacks on health facilities in Israel.  

Added Zakaria, “the WHO surveillance system does not have a mandate to investigate attribution of attacks,” referring indirectly to critics who have said that some of the attacks on Gaza health facilities, attributed to Israel, involved misfired Hamas or Islamic Jihad missiles.  

The combined factors of displacement and crowded conditions, lack of adequate water and sanitation, and lack of medical capacity is leading to a rising level of respiratory and water-borne illness, meningitis, Zakaria added.

While humanitarian flows have increased, with a total of 3,000 aid trucks crossing into Gaza via Egypt’s Rafah cross since aid flows began in late October, “this is not nearly enough,” Zakaria said. 

“We needed 500 trucks per day. And even during the [humanitarian] pause only 220 trucks passed for one day to meet needs, we require more crossings,” she said, concluding that WHO is “glad to hear” that the Kerem Shalom border crossing between Israel and Gaza may reopen for humanitarian convoys.  

Scenes of devastation seen first-hand

Gaza City is “utter devastation” says the WHO Representative Rick Peeperkorn.

Speaking from Gaza, WHO representative to the Occupied Palestinian Territories, Dr Rick Peeperkorn, described the “scenes of utter devastation,” he had observed during his mission Saturday to Al Ahli Baptist Hospital, located in the epicentre of Gaza’s most war-battered northern district, which Israel now largely controls. 

“Gaza City has changed beyond belief,” Peeperkorn reported. “It’s utter devastation. It’s like a wasteland, even though there are still many people, children, old men and women around. There are not only patients in the wards, but also in the library, and even the church is crowded with patients on the floor, on stretchers, on chairs. 

“Having worked for more than seven years in Afghanistan, I’ve seen some grim situations.  I’ve never seen this before,” he said, describing doctors forced to perform amputations on wounded Palestinians because they lack the necessary surgical capacity, equipment and medicines to otherwise save the limbs. 

Palestine health minister: Israel targeting ever aspect of life in Gaza 

Palestinian Health Minister, Dr. Mai al-Kaila

Palestinian Health Minister Dr Mai el-Kaila, described the situation as an “unparalleled humanitarian catastrophe that defies international law and shatters the very sense of our shared humanity.”

“Israeli military occupation forces have relentlessly targeted every aspect of life in Gaza, sparing no one – from women, children, and disabled individuals to schools or hospitals, shelters, facilities and ambulances,” said el-Kaila, speaking from Ramallah, the seat of the Palestinian Authority, which has rallied to the side of its rival, Hamas, in the Gaza emergency. 

“Even the so-called safe corridors have not been spared, resulting in the loss of hundreds, of thousands of severe injuries, to forcibly displaced individuals,” el-Kaila said.  

She noted the risks posed by the degraded sanitary conditions where 160 people, on average,  share the same toilet and 700 people share a single shower.  

 “Some 400 tons of garbage per day are accumulating,” she noted, and “medical waste at hospitals is not removed. These factors lead to increased public health threats.

She called for the “unconditional and immediate entrance of humanitarian aid including food, water and medical supplies”; cessation to the “targeting [of] essential services such as health facilities, medical personnel, water, electricity and emergency services,” and a broader UN enquiry into the conduct of the war. 

“The international community must end impunity for Israeli occupied forces, and call the perpetrators accountable for the brutal actions and crimes. Now is the time for this action;  the word cannot stand neutral while innocent lives are lost and the basic rights of the Palestinian people are compromised,” she said. 

Israel: Hamas broke the ceasefire on 7 October 

Israeli Ambassador to the UN in Geneva, Meirav Eilon Shahar

Meanwhile, Israeli Ambassador to the UN in Geneva, Meirav Eilon Shahar, denounced what she described as the double standard being displayed by many countries, when it comes to Israel. 

“Today’s session is the only session ever convened here in Geneva on a specific conflict,” she said. “No special session was called on the health situation in Syria, Yemen, Sudan or many other situations. Did the victims of these conflicts matter less or does the world play by a different rulebook when it comes to Israel?” she asked. 

“The reality  is that on October 6, there was a ceasefire with Hamas. On October 7, we woke up to a new reality when thousands of terrorists entered Israel and systematically tortured and mutilated, murdered women, men and children on an unimaginable scale. 

“They entered with one directive, spare no one, capture innocent people, rape women and girls. They directly targeted Israeli medical personnel, first responders. More than 240 people were taken hostage and 137 still remain in Gaza, including 11 months old Kfir Bibas, and his four-year-old brother, Ariel. 

“Since October 7 over 11,500 rockets have been fired indiscriminately at Israeli cities, and this continues every day, hitting hospitals, schools and residential buildings.  In response to October 7, Israel declared war on the terrorist organisation Hamas. Our operation is directed towards Hamas. It has never been against the Palestinian people. 

“I recognise the suffering in Gaza. Let there be no mistake. However, Hamas is responsible for this suffering… Israel is operating against the terrorist organisation, which operates from within, underneath, and adjacent to hospitals, schools and UN facilities. 

The Israeli ambassador also called out WHO: “Even after the scope and scale of Hamas brutality was exposed on October 7, many in the international community, including the World Health Organization, continue to give Hamas a massive free pass. WHO has shamelessly reiterated that it only knows what is happening above ground in the Al Shifa Hospital and not what is happening below…

“If this EB session serves any purpose, it will only encourage Hamas actions,” she concluded. “It  gives them a green light to use Gazans as human shields… It is a reward for Hamas disdain for the sanctity of human life. If we stop now, Hamas will carry out another October 7. They say so publicly….  This is the reality that the [EB] decision … will blatantly ignore.”

Cuba denounces alleged Israeli ‘war crimes’  

Responding to Israel’s remarks, Palestine’s Ambassador to the UN in Geneva, Ibrahim Khraishi, denied Israeli reports of Hamas missile misfires on Gaza hospitals, and Hamas tunnels and weapons caches in and around health facilities, homes and schools as “lies.” 

But he contended that Israel’s position in the conflict was not parallel to that of the Palestinians in any case. 

 “It all comes down to self determination and self-defence,” Khraishi said. “Self defence does not exist for Israel because it is an occupying power.”

During the hours’ long debate, over two dozen other nations, including India and Pakistan, Malaysia and Turkey, South Africa, Namibia and Angola, and states across the Middle East and North Africa, weighed in on the conflict, mostly focusing on Israel. 

Said South Africa, “These developments tragically form part of an ongoing pattern of over 75 years of oppression, occupation and conflict.” 

Cuba described the Israeli military actions as “genocide and a crime against humanity.”

“Namibia is deeply concerned over the increasing escalation of violence and the collective punishment of the Palestinian people by the occupying forces,” said Namibia’s delegate to the special EB session. “Basic infrastructure like housing have been reduced to rubble… The cutting of basic utilities has been weaponised to inflict further suffering on top of the bombs and bullets – and the insecurity of civilians being ordered at short notice from one place to the other, none of which are suitable for human habitation.

“But the gathering momentum is undeniable,” the delegate added, of the global political pressure being applied on Israel. “It is Namibia’s hope, having lived under similar conditions as the Palestinians are currently enduring, that justice will manage to prevail.”

US: Hamas has further genocidal intentions 

US Ambassador to the UN in Geneva, Bathsheba Nell Crocker in the 10 December EB debate over the Gaza humanitarian crisis.

Meanwhile, the US and Canada, as well as European countries such as Germany, Denmark and Paraguay, expressed varying levels of dismay, in turn, over what they described as insufficient criticism of Hamas actions in the WHO resolution. 

“We agreed not to block consensus on the text, but we do not agree with preambulatory  paragraph 8,” said US Ambassador to the UN in Geneva, Bathsheba Nell Crocker. She stressed that calls for a cease-fire,  “are not only unrealistic but dangerous. A ceasefire would simply leave Hamas in place and able to regroup and repeat what it did on October 7. Hamas does not dispute this.” 

Added the US in closing remarks: “Hamas actually does have genocidal intentions against the people of Israel, and have said so explicitly, that they would like to see Israel wiped off the map.”

Said Denmark, “We regret the resolution was not more balanced on the matter of hostages and the use by Hamas of hospitals as shields.”    

Added Germany, which described itself as the world’s largest donor to the Gaza emergency response: “Like any other state, Israel has the right to defend itself in accordance with obligations under international law.

“Hamas must unconditionally and immediately release all hostages and stop its rocket attacks, and refrain from using civilians as well as civilian infrastructure for military purposes, especially medical infrastructure, like hospitals or ambulances. We do regret that these aspects are not reflected in the current resolution.” 

Tedros’ conclusion: The medicine most needed is hope 

Despite the bitter polarisation seen, the WHO governing body remains the first in a UN fora to have made a consensus statement on the crisis, said Tedros in closing remarks following the vote by the 34-member body. But no resolution by the global health body can really address the deeper roots of the conflict, which are fuelling the crisis, he stressed. 

“I understand Israel’s need to protect it’s people from further and future attacks, and to live in peace and security,” Tedros said. 

“And I likewise understand the need of the Palestinian people to live in peace and freedom. 

“We must continue to believe that these are possible and not mutually exclusive.

“As always, the medicine that the people of Israel and the occupied Palestinian territory needs the most is not one we can deliver in a truck, or administer in a syringe.

“It’s the most precious medicine and often the most rare: hope.”

Image Credits: WHO report to the Executive Board , WHO/EMRO .