Palestinian civil defence responders search the rubble of a building  for survivors in the aftermath of an Israeli air strike in the Gaza Strip.

There has been a massive rise in diarrhoea, respiratory infections and skin conditions and in Gaza since Israel’s siege and bombing of the territory began in early October, disrupting supplies of clean water, sanitation, food, fuel and leaving thousands homeless.

Since mid-October, over 33,551 cases of diarrhoea have been reported in the area, over half affecting children under age five, according to the World Health Organization’s (WHO) Eastern Mediterranean Region (EMRO). During 2021-2022, the average number of diarrhoea cases in children under five was around 2,000 a month.

Almost 55,000 people have been diagnosed with upper respiratory tract infections, over 12,600 with rashes, almost 9,000 with scabies and over 1000 with chicken pox.

United Nations (UN) aid agencies have also warned of cholera, typhoid and measles outbreaks as many people lack access to clean water, food and shelter.

No water in Gaza

In northern Gaza, the two main sources of drinking water, a desalination plant and a water connection from Israel, have been shut down for “several weeks”, while on 4 and 5 November, seven water facilities across the Gaza Strip were directly hit and sustained major damage, including three sewage pipelines in Gaza city, two water reservoirs (in Rafah and Jabalia refugee camp) and two water wells in Rafah, according to the UN’s Office for the Coordination of Human Affairs (OCHA).

OCHA said that by Thursday, all of the Gaza Strip’s 120 municipal water wells were expected to shut down as fuel to pump water is depleted. Israel said last week that it had restored supplies from two pipes into southern and central Gaza, one of which was damaged in the fighting. It is unlikely those supplies can reach the embattled north. 

Israel has blamed Hamas’s monopolization of scarce resources such as food, fuel and water for its own military purposes for the escalating humanitarian crisis in Gaza. But the daily volume of drinking water Israel has allowed to cross the Gazan border with Egypt is enough to serve just 4% of Gaza’s population, OCHA said in its daily update on Wednesday.

WHO EMRO reports that “lack of fuel has led to the shutting down of desalination plants, significantly increasing the risk of bacterial infections like diarrhoea spreading as people consume contaminated water” and has “also disrupted all solid waste collection, creating an environment conducive to the rapid and widespread proliferation of insects and rodents that can carry and transmit diseases”.

It added that “damaged water and sanitation systems, and dwindling cleaning supplies” have made it almost impossible for health facilities to maintain basic infection prevention and control measures. 

“These developments substantially increase the risk of infections arising from trauma, surgery, wound care and childbirth,” it added. An estimated 50,000 women are pregnant in Gaza.

Emergency Medical Teams (EMTs) have been deployed to support Shifa, Aqsa, and Abu Yousuf Al Najjar hospitals in expanding their emergency departments’ capacity.

‘Disastrous conditions’ at biggest hospital

Meanwhile, the medical conditions at Al-Shifa, the largest hospital in the Gaza Strip and one of the oldest Palestinian health institutions, are “disastrous”, according to a joint statement by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and WHO. 

Fierce fighting between Israel and Hamas has reportedly been raging for the past several days in the vicinity of the hospital, an area Israel has described as a major Hamas command and control centre.

“There are currently almost two patients for every bed available. The emergency department and wards are overflowing, requiring doctors and medical workers to treat wounded and sick patients in the corridors, on the floor, and outdoors.”

“The number of wounded increases by the hour while patients are undergoing immense and unnecessary pain as medicines and anaesthetics are running out,” they added.

Dr Marwan Abusada, the hospital’s head of surgery, told The Guardian that they have “zero capacity”. 

“We have 153 patients at the ER. All the beds are occupied. We have no space for patients to go after they undergo surgery. We have a type of worms [in] the wounds after the surgery. Most injuries and surgeries have no follow-ups as the medical teams cannot cope with the influx of injuries every hour,” said Abusada.

On Wednesday, the UNRWA facilitated the delivery of WHO’s emergency medical supplies and medicines to Al-Shifa Hospital in Gaza City,” only the second delivery of lifesaving supplies to the hospital since the escalation of hostilities and the total siege of Gaza began”.

Out of almost 1.5 million displaced people, nearly 725,000 are in 149 UNRWA facilities, while 122,000 are sheltering in hospitals, churches, and other public buildings, and about 131,134 in 94 non-UNRWA schools, while others are living on the streets near hospitals.

Shelters run by UNRWA are so overcrowded that an average of 160 people are sharing a toilet and there is one shower for every 700 people, according to the agency.

France hosts Gaza conference

Delegations from over 80 countries and organisations met on Thursday at the International Humanitarian Conference for the Civilian Population in Gaza hosted by France on the eve of its annual Paris Peace Conference.

United Nations (UN) Under-Secretary-General for Humanitarian Affairs Martin Griffiths told the conference that the UN “cannot be part of a unilateral proposal to push hundreds of thousands of desperate civilians in Gaza into so-called safe zones”  if there is no agreement between all the parties on the establishment of these zones.

Calling for an immediate humanitarian ceasefire, he also expressed concern that “satisfactory conditions do not exist anywhere in Gaza to ensure adequate shelter, food, water, sanitation and health”.

Meanwhile, International Rescue Committee President David Miliband told CNN on Wednesday that a humanitarian ceasefire in Gaza needed to last for an “absolute minimum” of five days to allow aid agencies to do their work. Israel gave people in northern Gaza four hours to leave the territory on Wednesday before it intensified its attacks again.

“There needs to be a massive scale-up of the aid flows – that’s medicines, that’s non-food items, that is food, that is water, the basics of life and the fuel to get those goods around the Gaza Strip,” said Miliband.

“Second, you can’t deliver aid without aid workers,” he added, but it was unsafe for them to operate. 

“Thirdly — essential — we’ve got to be able to have safety for civilians who come to receive aid when they bring their kids when they bring their wounded, they’ve got to be able to be safe in a health centre,” added Miliband, warning of the threat of cholera, measles and typhoid.

On Thursday, the US White House announced that Israel had agreed to daily four-hour military pauses in northern Gaza, which would be announced three hours beforehand. They are intended to encourage people to flee to the south via two humanitarian corridors that have also been agreed upon.

No end in sight as war enters second month 

A Palestinian Civil Defense vehicle was struck by an Israeli air strike on 21 October. The strike killed between 6 and 10 civilians, according to Airwars.

As the brutal war between Israel and Hamas presses on into its second month, over 10,569 people – one in every 190 Palestinians living in Gaza – are dead, according to the Gaza Health Ministry. The Ministry does not distinguish between combatants and civilians.

Nearly 1,400 Israelis and foreign nationals have been killed in Israel, the vast majority on 7 October, according to Israeli authorities. Some 240 men, women and children kidnapped by Hamas and other militias on the day of the attack continue to be held hostage. Their locations within Gaza and the number still alive are unknown.

UN Secretary-General Antonio Guterres strongly condemned both Hamas’s brutal and deadly assault on thousands of Israeli civilians on 7 October, as well as its war tactics of embedding military facilities into critical civilian infrastructure and using civilians as “human shields,” in an interview with Reuters on Wednesday.

Hamas has fired over 9,500 missiles into Israeli cities since its 7 October incursion into 22 Israeli communities where civilians  were shot and burnt to death in their homes. Hamas-aligned militias in southern Lebanon have also stepped up their missile attacks into northern Israeli cities, reaching as far as the outskirts of Haifa.

Guterres also emphasised the deadly toll the massive Israeli airstrike campaign is inflicting on civilians in Gaza: “When one looks at the number of civilians that were killed with the military operations, there is something that is clearly wrong.”

The first 19 days of the war saw Israel conduct over 7,000 airstrikes on Gaza, killing an estimated 6,500 people. The 7,000 bombs dropped on Gaza – a territory half the size of New York City – in under three weeks outpaced even the most intense month of the bombing campaign by the US-led coalition against the Islamic State in Iraq and Syria (ISIS), according to Airwars.

The rate at which Israeli airstrikes are hitting Gaza ranks as one of the most intense campaigns of the 21st century. The deadly toll on humanitarian, medical and media workers has been unprecedented.

The war in Gaza is already the deadliest conflict for journalists since the Committee to Protect Journalists (CPJ) began gathering data in 1992. As of 9 November, 39 journalists – 34 Palestinian, four Israeli and one Lebanese – were confirmed dead, according to the CPJ. This accounts for 70% of journalists who have lost their lives reporting since the start of 2023.

The situation for humanitarian workers is even more dire. UNRWA announced on Wednesday that two members of its staff had been killed in the preceding 24 hours. Seven more UNRWA staffers were confirmed dead by the time the agency’s Commissioner General, Philippe Lazzarini, spoke at the international conference on Gaza in Paris on Thursday.

The 99 UNRWA staffers killed since the onset of the war is “the highest number of United Nations aid workers killed in a conflict in the history of the United Nations,” the agency said.

Civilian lives buried beneath a war of numbers 

The deaths in Gaza include at least 2,550 women and 4,237 children, with another 25,956 people injured, Gaza’s Health Ministry has said. A further 2,260 people are reported missing, many presumed to be buried beneath the rubble left behind by Israeli air strikes, including 1,270 children. The Gaza Health Ministry is controlled by Hamas. 

More than 1.5 million Palestinians – three-quarters of the population of Gaza – have been displaced since the start of Israel’s military operations in the enclave. The flow of aid on which Gazans depend has slowed to a trickle. In peacetime, around 500 trucks transporting humanitarian aid and commercial goods entered Gaza every day. But a month after the Hamas attack on Israel, just 650 trucks had been allowed to enter the enclave. 

One out of every 19 people in Gaza are either injured, missing, or dead, according to Gaza Health Ministry figures. Hamas is estimated to have a fighting force of between 20,000 and 30,000 combatants – 1.5% of the population of Gaza. Children, meanwhile, make up around 47% of Gaza’s population, according to UNICEF. 

“We need to distinguish – Hamas is one thing, the Palestinian people (are) another,” said Guterres. “If we don’t make that distinction, I think it’s humanity itself that will lose its meaning.”

Gilad Erdan, Israel’s Ambassador to the United Nations, shot back at the UN chief, stating that Israel is working to limit civilian casualties and has opened an evacuation corridor to South Gaza, while Hamas targets Israeli civilians. 

“Would the Secretary-General dare say that since the number of German civilian casualties during World War II was higher than American or British civilian casualties, it meant that something was ‘wrong’ with the US and UK military operations when fighting a genocidal regime?” Erdan told Reuters, adding that the death toll provided by the Gaza Health Ministry should not be trusted. 

Israeli officials have repeatedly disputed the casualty figures provided by the Gaza Health Ministry, citing its lack of distinction between civilian and military casualties and influence exerted by Hamas over death tolls. US President Joe Biden has voiced similar scepticism, stating on October 27 that he had “no confidence in the number that the Palestinians are using”. 

However, the Gaza Health Ministry’s death tolls from previous wars with Israel have proven reliable. The numbers provided by the Ministry during clashes with Israel in 2008, 2014 and 2021 all matched – with small discrepancies – the post-war tallies reached by UN, independent, and even Israeli investigations. 

“The numbers may not be perfectly accurate on a minute-to-minute basis,” Michael Ryan, head of the WHO’s Health Emergencies Program said of the Gaza Health Ministry figures. “But they largely reflect the level of death and injury.”

Children dying at an unprecedented rate 

The estimated 4,237 children killed in Gaza account for 40% of all deaths since the war began, a staggering rate with few precedents. 

Three weeks into the war, Save the Children revealed the number of children killed in Gaza was greater than the total number of children who lost their lives in all global conflicts since 2019. A further 980 children in Gaza have been confirmed dead since that report. 

“An average of about 160 children are killed every day based on the figures of the [Gaza] Ministry of Health,” WHO spokesperson Christian Lindmeier said at a media briefing on Tuesday.

Seven years into the ongoing Yemeni civil war, a conflict in which both sides have employed child soldiers and notorious for its high rate of child casualties, 3,773 children – fewer than in just one month of the war in Gaza – have died, according to the UN. The deadliest conflict for children in recent decades is the Syrian civil war, in which 27,126 children were killed in over 10 years of fighting. 

If child deaths continue to proceed at the current rate, the number of children killed in Gaza would match that of more than 10 years of Syria’s civil war in around seven months.

The historic rate at which children are losing their lives in Gaza is transforming the enclave into “a graveyard for children”, Guterres said on Monday. 

“Every year, the highest number of killings of children by any of the actors in all the conflicts that we witness is the maximum in the hundreds,” said Guterres in an interview with Reuters on Wednesday. 

“We have in a few days in Gaza thousands and thousands of children killed, which means there is also something clearly wrong in the way military operations are being done,” he stated.

Hamas’s bloody calculation

Flames and smoke billow during Israeli strikes in Gaza, which have caused an unprecedented level of destruction since the 7 October Hamas incursion into Israel.

To Hamas leadership, the deaths and displacement of Palestinian civilians are not a surprising or unwanted outcome, but a pivotal part of a bloody calculation, according to new reporting based on interviews with its senior leadership in Doha, Qatar. 

“We succeeded in putting the Palestinian issue back on the table, and no one in the region is experiencing calm,” Khalil al-Hayya, a high-ranking member of Hamas’s leadership, told the New York Times of the largest massacre of Jews since the Holocaust.

“What could change the equation was a great act, and without a doubt, it was known that the reaction to this great act would be big,” al-Hayya added when asked about the scale of civilian deaths in Gaza.

The terror group’s leaders have repeatedly declined to express any remorse for the brutal actions of its fighters in the raid on Israel and its citizens that left 1,400 dead and more than 200 taken hostage.

“We had to tell people that the Palestinian cause would not die,” al-Hayya concluded, regarding the thousands of Palestinian and Israeli lives lost since the Hamas attack on 7 October.  

On Thursday, Palestinian terror group Islamic Jihad released a video of two hostages, offering their release. The captives include a 77-year-old woman and a 13-year-old boy, abducted with his brother, father and partner, from Kibbutz Nir Oz.

Negotiations are reportedly underway in Doha between Israel, the United States and Qatari mediators over the possibility of the release of 10 to 15 hostages in exchange for a one-two-day humanitarian pause, Reuters reported.  

“Israel is a country that has no place on our land,” declared Hamas official Gazi Hamad in a Lebanese TV interview last week. “The existence of Israel is illogical….7 October, 10 October, 1 million October, it is justified.”

Elaine Ruth Fletcher contributed to this report. 

Image Credits: Airwars, WHO EMRO.

Pandemic agreement negotiations are underway again this week

An effective pandemic agreement will need to include “accountability mechanisms” to ensure that countries implement the terms – and these will need to be independently monitored, according to new research published in BMJ.

“Accountability mechanisms are used through a variety of methods across global treaties and governance mechanisms to varying degrees of effectiveness,” argue the researchers, based on their evaluation of other global treaties and interviews with experts. 

“The pandemic agreement should have accountability mechanisms built into it from the start to increase the likelihood of countries complying with the obligations they sign up for.”

 

‘Soft incentives’ for compliance

While finding consensus is the current imperative for the INB, there is a risk that countries will simply fail to implement the terms of a pandemic agreement.  During the COVID-19 pandemic, for example, many countries did not comply with the  International Health Regulations (IHR), despite the fact that they are legally binding.

To enhance compliance with a pandemic agreement, the researchers – mostly from Spark Street Advisors – argue for the provision of “soft incentives” such as “technical and material resources” to help countries.

“Reputational incentives” could also assist with compliance, they add, arguing against “the harms of sanctions and benefits-based incentives”.

But compliance with the terms of the agreement should not simply rely on countries’ self-reporting, as is the case with many international agreements.

“The pandemic agreement should establish, as part of its institutional arrangements, an independent monitoring committee, tasked with producing regular assessments of state parties’ compliance with the pandemic agreement and the timeliness, completeness and accuracy of self-reporting,” they argue.

This monitoring committee “should be politically, financially, technically and operationally independent of the WHO and donors”, and able to” triangulate” information from a diverse range of sources including civil society about countries’ compliance.

It would report to a high-level political body to promote compliance with the pandemic agreement.

‘Find common ground between public health and profit’

Meanwhile, Dr Tedros Adhanom Ghebreyessus, the Director-General of the World Health Organization (WHO), appealed to member states negotiating a pandemic agreement to find “common ground”  between equitable access and innovation; protecting public health and making a fair profit; global health security and national or regional interests. 

Addressing a closed session of the seventh meeting of the intergovernmental negotiating body (INB) in Geneva on Wednesday, Tedros warned that “a pandemic agreement that fails to ensure collective security and equity in all its forms, fails”. 

Referring to “numerous meetings” in the almost two years since a special session of the World Health Assembly decided to establish the INB, Tedros said “I believe strongly that this [negotiating] text may help you come closer together on the path towards consensus.

“No one is pretending your work is easy. I know it is not. It is not surprising that, with 194 member states, reaching consensus is not straightforward. But that does not mean it is unachievable,” said Tedros, whose INB speech was released by WHO.

Sovereignty ‘nonsense’

Tedros also appealed to member states to counter the “torrent of fake news, lies, conspiracy theories and mis- and disinformation”. 

“There are those who say – whether they believe it themselves or not – that the accord will cede sovereignty to WHO; that it will give the WHO Secretariat power to impose lockdowns or vaccine mandates on countries, and other nonsense. 

“You know and we know that the agreement will give WHO no such powers.  We need your support to put this nonsense to rest.  We need your support to counter these lies, by speaking up at home and telling your citizens that this agreement will not, and cannot, cede sovereignty to WHO. Period.”

The seventh INB meeting started on Monday, will break on Friday, and then resume on 4-6 December.

As the world teeters on the brink of climate catastrophe, major fossil fuel-producing nations plan to expand production.

Amidst a global chorus calling for urgent action on climate change, major fossil fuel producers are doubling down on their plans to expand production, defying climate science and “throwing humanity’s future into question”, a UN report revealed on Wednesday.

The report, compiled by the United Nations Environment Programme (UNEP) in collaboration with academic partners, scrutinized the plans of the 20 largest fossil fuel-producing countries, responsible for a staggering 84% of global carbon emissions and roughly three-quarters of the world’s fossil fuel consumption in 2021. 

The findings paint a grim picture: governments’ 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.

The analysis found national fossil fuel plans would result in 460% more coal, 83% more gas, and 29% more oil production in 2030 than the world can afford to burn on its increasingly miniscule 1.5 C carbon budget.

The findings underscore the persistent gap between national climate pledges and fossil fuel production, a worrisome trend that has remained largely unchanged since the UN first quantified it in 2019.

“The addiction to fossil fuels remains deeply entrenched in many nations,” said Inger Andersen, Executive Director of UNEP. “Governments must stop saying one thing and doing another … [these] plans to expand fossil fuel production are undermining the energy transition needed to achieve net-zero emissions, throwing humanity’s future into question.” 

“The fossil fuel production gap, the difference between governments’ plans and projections and levels consistent with limiting warming to 1.5°C and 2°C, remains large and expands over time,” the report found.

None of the top 20 fossil fuel-producing countries have committed to aligning their output of oil, coal and gas to limit warming to 1.5°C, despite 17 committing to net-zero emissions pledges, the report found. All continue to subsidise, support and plan expanded fossil fuel production. 

The combined levels of coal, oil, and gas production planned by 10 high-income countries alone would already exceed 1.5°C-consistent pathways for each fuel by 2040, the report found.

The lack of progress by major polluters in realigning their production of fossil fuels with global climate targets comes against a backdrop of new records for global greenhouse gas emissions, sea levels, and fossil fuel subsidies set in 2022. In 2023, one-third of days have seen average global temperatures exceeding 1.5°C over pre-industrial levels.

“The whole world is clinging to the handrails on a boat that is lurching through increasingly turbulent seas,” said Andersen. “Nations must unite behind a managed and equitable phase-out of coal, oil and gas — to ease the turbulence ahead and benefit every person on this planet.”

UN Secretary-General Antonio Guterres, a vocal critic of fossil fuel interests, expressed dismay at the report’s findings. “Governments are literally doubling down on fossil fuel production,” he said, emphasizing the need for credible commitments to ramp up renewables, phase out fossil fuels, and boost energy efficiency while ensuring a just, equitable transition.

India, Saudi Arabia, and Russia lead fossil fuel expansion surge

Government plans and projections would lead to an increase in global coal production until 2030, and in global oil and gas production until at least 2050, the end of the time frame covered by the report. These findings contrast with those of the IEA, which forecast a peak in demand for all three fossil fuels by 2030.

India, Saudi Arabia, and Russia are spearheading the global surge in fossil fuel production, with their expansion plans accounting for the largest share of carbon emissions for coal, oil and gas, respectively, according to the report. 

India’s coal production plans dwarf any other nation, with its Ministry of Coal projecting domestic coal production to more than double to 1.5 billion tonnes by 2030. In March 2022, the Indian government set a goal of increasing production by state-owned Coal India Limited (CIL) alone to one billion tonnes by 2024.

Saudi Arabia, which relies on oil and gas production for half of its GDP, is planning the largest single-country increase in oil extraction. Documents from state-owned Saudi Aramco, which controls nearly a fifth of global oil output, suggest a 47% increase in production by 2050. Aramco also plans to ramp up natural gas production to meet future demand.

Russia, the world’s largest gas exporter, also has ambitious expansion plans. The most recent government figures project coal production increases of between 11% and 53%, and between 6% and 31% for gas by 2035. 

Russia’s energy exports have become a lifeline for the country’s foreign reserves and economy, which have been severely strained by international sanctions and wartime expenditure stemming from its invasion of Ukraine in February 2022.

The United States, Canada, Australia, Norway, and the United Kingdom also play a significant role in fossil fuel expansion plans. According to a recent analysis by Oil Change International, these five countries account for 51% of planned new oil and gas extraction by 2050. 

The United Arab Emirates, hosts of the upcoming UN climate summit starting on November 30, plans to boost its oil production by one million barrels per day by 2027 and increase its natural gas production by 259% by 2028 as part of a $150 billion investment plan in its national oil company, ADNOC. Sultan al Jaber, president of the UN climate summit, serves as the president of ADNOC.

“Governments offer a variety of rationales for increasing production: reducing import dependency, generating government revenue … and winning out as one of the last producers in a shrinking market,” Michael Lazarus, a lead author of the report, said at a closed-door media briefing on Monday.

“But when you take all these reasons together, that’s what leads to the production gap itself – the desire for each country to maximize their own production,” Lazarus added.

Money, money, money

The top 10 countries in extraction-based greenhouse gas emissions account for 75% of the global total, while the top 35 countries account for 96% (data represents 2021 levels).

The report’s findings underscore the crux of the fossil fuel crisis: governments and private companies continue to reap massive profits from fossil fuel production, creating a disincentive for any party to exit the lucrative market. 

Amidst an energy crisis triggered by Russia’s invasion of Ukraine, which caused oil and gas prices to skyrocket, major oil companies more than doubled their annual profits to a record $219 billion in 2022. Buoyed by record profits, major petroleum companies have quietly retreated from their already modest climate commitments.

In October, American fossil fuel giants ExxonMobil and Chevron reaffirmed their expansion plans, both announcing acquisitions of smaller shale producers in the United States for a combined total of over $100 billion. The United States is the largest producer of oil and gas in the world. 

In India, low monsoon rainfall over the summer months led to a surge in electricity consumption. Adani, the country’s second-largest power producer, responded by amplifying coal generation, from which it raked in $792 million, compared to $84 million the year prior, Semafor reported this week.

The Organization of the Petroleum Exporting Countries (OPEC), the global oil cartel that supplies 51% of the world’s oil and controls 81% of proven oil reserves, forecast in its annual report released last month that it expects oil demand to increase by 17% by 2045.

In the foreword of the report, OPEC Secretary General and Kuwaiti oil executive Haitham Al Ghais cautioned against calls to halt investments in new oil projects, asserting that such measures could lead to “energy and economic chaos.”

Scientific consensus and expert bodies agree that new oil and gas field development is incompatible with all pathways for limiting global warming to 1.5 degrees Celsius.

“This is the heart of the problem,” said Ploy Achakulwisut, a lead author of the report. “Major producers are not willing to transition from fossil fuel production.” 

Expanding fossil fuels: Economic ‘insanity’ 

Despite plans by leading fossil fuel producers to expand output, the IEA projects fossil fuel demand will peak by 2030 due to the accelerating economic momentum of renewables.

The International Energy Agency’s (IEA) latest annual report, released in October, projects a significant shift towards renewable energy sources in the coming decade. By 2030, renewables, including solar, wind, and hydropower, are expected to account for nearly half of the global electricity mix, up from around 30% today.

IEA Executive Director Fatih Birol emphasized the irreversible nature of this transition, declaring it “unstoppable.”

“It’s not a question of ‘if’, it’s just a matter of ‘how soon’ – and the sooner the better for all of us,” said Birol. “Taking into account the ongoing strains and volatility in traditional energy markets today claims that oil and gas represent safe or secure choices for the world’s energy and climate future look weaker than ever.”

This rapid transition towards clean energy renders planned expansions in fossil fuel production economically questionable, according to experts.

“Government production plans and targets, help to influence legitimise and justify continued fossil fuel dependence,” said Achakulwisut. “At the same time, many of these investments and infrastructure are at risk of becoming stranded assets as the world decarbonises.” 

Despite the growing adoption of green technologies, the allure of fossil fuel profits continues to hold sway, preventing countries from decisively stepping away from these energy sources. This reluctance stems, in part, from fears of losing out on market share in a shrinking market. 

“Despite their climate promises, governments plan on ploughing yet more money into a dirty, dying industry, while opportunities abound in a flourishing clean energy sector,” said Neil Grant, an environment analyst at Climate Analytics and a co-author of the report. “On top of economic insanity, it is a climate disaster of our own making.”

Major fossil fuel producers resist loss and damage fund

The US, the largest producer of oil and gas in the world, threatened earlier this week to exit loss and damage fund negotiations altogether.

As the largest fossil fuel-producing nations refuse to halt their expansion of coal, oil, and gas production, they are also resisting calls to compensate vulnerable countries for the climate-related damages they are causing and help them prepare for the escalating dangers of a warming climate.

Tensions are escalating ahead of the crucial UN climate summit, COP28, over the establishment of a loss and damage fund, a cornerstone of the global climate response and the crowning achievement of last year’s UN climate summit in Egypt.

The fund, aimed at compensating developing nations for the impacts of climate change, was nearly derailed at a recent preparatory meeting in Abu Dhabi due to financing disagreements led by the United States, which signalled that it is unwilling to provide any funding beyond voluntary contributions.

Developing countries, bearing the brunt of climate change impacts, have staunchly opposed the US proposal to house the fund at the World Bank, citing the institution’s outdated structure and excessive US influence.

China is also playing a pivotal in discussions surrounding the fund, urging the United States to make substantial contributions while remaining careful to sidestep any financial obligations of its own.

Outi Honkatukia, co-chair of the Abu Dhabi negotiations, called reaching an agreement on the fund “mission impossible”. A shaky agreement was reached, but it fell short of consensus, leaving the fund’s future uncertain. For now, the fund will be housed at the World Bank, a key U.S. demand, but developing countries hope this is a temporary step toward an independent fund. The battle will continue at COP 28 in Dubai.

“The US’s inability to agree on even a watered-down text highlights their lack of commitment to establishing an effective fund,” Lien Vandamme, a senior campaigner at the Center for International Environmental Law, told Politico.

The fate of the loss and damage fund hangs in the balance, casting a shadow over the upcoming COP28 climate summit. Its failure to materialize could jeopardize the overall progress of climate negotiations.

Image Credits: UNEP, UNEP .

A tobacco crop in northern Malawi

BLANTYRE, Malawi – Boyden Ndlovu of Mzimba district, one of Malawi’s tobacco growing districts located in the northern region says that his lifetime has been synonymous with tobacco farming.

Tobacco has been a mainstay of Malawi’s economy, historically generating about 70% of export revenue and now accounting for over half – yet the country finally ratified the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) in August this year.

The FCTC, adopted by the World Health Assembly in 2003, is designed to protect present and future generations from the devastating impact of tobacco consumption and exposure to tobacco smoke by reducing both demand and supply of tobacco. 

Article 17 of the Convention requires signatories to promote economically viable alternatives to tobacco.

But Ndlovu, although knowledgeable about crop diversification, swears he will never quit tobacco farming because it’s the only “lucrative crop” in Malawi. 

“My parents educated us with proceeds from tobacco farming. I have never had a white-collar job in my life, I’m content being a farmer,” says Ndlovu, who has been a tobacco farmer for 35 years.

He believes tobacco farming has always been very profitable because the prices are in dollars, boasting that the 2022/23 farming year had better prices with an average selling price of $2.35 per kilogram. 

At first, Ndlovu explains, he farmed tobacco on all of his 35 hectares, but this has changed over the years due to fluctuating tobacco prices. He now farms tobacco on only eight hectares, growing food crops such as maize, legumes, fruits and vegetables on the rest.

“Many tobacco farmers have moved away from growing tobacco to legumes and other presumably cash crops. Most farmers were discouraged by the global anti-smoking lobbies and erratic profits threatening the industry,” Ndlovu tells Health Policy Watch.

There were a few farmers in the last tobacco growing season, he adds. “I believe this contributed to the few to make more profits. Many farmers who moved away didn’t make much money from legumes. I’m foreseeing an increase in tobacco growers this year.”

Tobacco farmer Boyden Ndlovu of Mzimba district in Malawi

Industry manipulation

But Ndlovu’s tobacco “lucrative” farming is partly supported by the tobacco industry’s contract farming system. Farmers are granted loans by commercial banks that enable them to buy what they need to produce quality tobacco, backed by the tobacco companies’ guarantee that they will buy their tobacco. The loan amounts are deducted at source and farmers are given the remaining amount as their profit.

Dr Lonjezo Masikini-Phiri, a social science lecturer at the University of Bath and an expert on tobacco production in Malawi, observes that Malawi’s tobacco production is heavily influenced by the industry’s multinational companies. 

These companies prefer to buy African tobacco as it is cheaper, thus enabling higher profits. In addition, tobacco growing has decreased in the United States and United Kingdom.

Masikini also observes tobacco multinational companies have supported tobacco farmers to grow legumes alongside tobacco – largely to enrich the soil for tobacco, and possibly also to counter the anti-tobacco lobby’s argument that tobacco farming is undermining food production.

“Malawi should look ahead on what the ratification of the FCTC means. The country should use this opportunity to lobby for tobacco-shifting diversity projects or funding so that the farmers are attracted to food crop farming. This however requires a political will to be implemented,” he says.

Production decline

Malawi is one of the top five producers of tobacco in the world. Malawian tobacco is found in blends of nearly every cigarette smoked in industrialised nations including Camel and Marlboro brands, according to the Malawi Investment and Trade Centre. 

The main tobacco-growing countries in Africa are Zimbabwe (25.9% of total output), Zambia (16.4%), Tanzania (14.4%), Malawi (13.3%) and Mozambique (12.9%). n.

But Malawi’s Minister of Agriculture, Sam Kawale, told Health Policy Watch that the FCTC is not a threat to the country and that his ministry and the health ministry are working together to find ways to protect the population from tobacco harm and ,at the same time, stimulate the economy.

 “We have been encouraging farmers to diversify their crop production. This is important, even now that we have climate change. We are encouraging them to grow drought-, pest-, and disease-resistant crops, as well as invest in irrigation,” he said.

Dr Rosemary Hiscock, a research associate at University of Bath’s Department of Heath,  says the amount of land used to grow tobacco in Africa appears to be declining.

Exports by tobacco leaf volume have been in decline since 2018 and export value has mostly been in decline since 2016.

The UN estimates that in 2019, 616 527 tonnes of tobacco leaf was exported from Africa. 

But in 2021, 519 121 hectares of land were used to grow tobacco and 564,960 tonnes were grown in Africa. Of this, 550 916 tonnes (98%) were estimated to be exported. 

The UN estimates that tobacco production took up less than 1% of land used for crop production in Africa.

Hiscock says Africa’s proportion of global leaf production is estimated to have increased slightly between 2012 and 2021 from 7% to 10%. 

“However the increase is related to a decline in the production of tobacco in the rest of the world rather than an increase in production in Africa,” she explains.

Clinging to ‘green gold’

Interestingly, farmers do not fear that the FCTC ratification could be Malawi’s economic suicide.  

Nixon Lita, CEO of the Tobacco Growers Association of Malawi (TAMA)

Nixon Lita, CEO of the Tobacco Growers Association of Malawi (TAMA), says farmers believe that Malawi being part of the discussions relating to tobacco through FCTC could offer alternative economic opportunities.

“We encourage farmers to diversify alongside tobacco but unfortunately tobacco production makes a lot of economic sense to farmers unlike most of the alternatives. Ratification does not demand a stop to growing,” he told Health Policy Watch.

Lita says that TAMA does not have data on tobacco farmers growing food, but notes that farmers usually reduce their tobacco production after a year of unsatisfying prices. 

“For example, 2023 good prices are likely to influence an increased production for the 2024 market. Previously, 2011 poor prices led to a slump in the production for the 2012 market,” he says.

“Farmers are attracted to tobacco upon being convinced of getting good profit after production and sales. Other alternative crops have failed to convince them of economic benefits, profitability and market access. There is a global demand for tobacco which Malawian farmers are failing to meet,” Lita stresses.

Malawian Agricultural expert Tamani-Nkhono Mvula says Malawi’s argument remains that if the amount of tobacco is reduced or halted, the livelihood of millions of people and national economy will be affected.

He notes that, although FCTC has led to a decrease in tobacco consumption in Europe and North America, it is increasing in countries like China.

“It’s the Chinese who are also buying a lot of Malawi’s burley tobacco.”

Nkhono-Mvula states that although farmers are encouraged to grow legumes, they are unlikely to be convinced of the same in the next farming season considering losses made in the last farming year.

He observes that tobacco’s biggest advantage is a well-organised value chain where farmers are guaranteed a market and a good price.

“If someone is growing soya, they are not sure of the market or profit. In such situations, it will be difficult for Malawi to stop growing tobacco as long as the tobacco market is going to be profitable and well structured,” Nkhono-Mvula said.

Vincent Kimosop, a Kenyan-based policy and governance expert, urges the Malawi government to progressively introduce measures to support farmers to adopt viable economic alternatives.

“This has been done in many countries including Brazil and there are lessons that can be borrowed by Malawi,” he observes. 

He cites the Kenyan example, where the government has taken steps to enlighten farmers that there is no future in tobacco farming although it is still struggling to find ready market alternatives.

Food crops quest

Nkhono-Mvula says that although tobacco is Malawi’s economic backbone, its agricultural land is geared towards maize, the staple crop, followed by cassava and sweet potatoes.

“It’s the estates that may have larger land for tobacco growing and not the small holder farmers. A tobacco crop in itself doesn’t deplete the soil, but it’s the chemicals used that do. They, in the long run, may have an effect on the soil. 

“The use of trees to dry the tobacco also leads to environmental degradation,” Nkhono-Mvula says.  

Hiscock suggests improving the supply chain for alternative crops, including building up extension services so farmers can grow other crops efficiently and ensuring there are guaranteed buyers for other crops.

She also suggests “educating farmers to understand that they rarely make long-term profits from tobacco”.

She also recommends tobacco control measures to reduce internal demand for tobacco, such as “tobacco taxes, ‘smoke free’ buildings, graphic picture warnings on packaging, plain packaging and banning flavoured tobacco products”.

Preparing to plant tobacco at Ndhlovu’s farmer. Tobacco farmers and workers are exposed to toxins from the fertiliser and nicotin.

Meanwhile, Malawi’s Ministry of Health (MoH) says the country ratified the FCTC to protect citizens  from the harmful effects of direct or indirect exposure to tobacco and its products, which is aimed at reducing lung cancer, cardiovascular and respiratory diseases.

“Malawi ratified to show high-level political commitment to reducing public health effects and from tobacco products. With that high level political commitment, Malawi can negotiate with investors on its diversity plans,” says MoH spokesperson Adrian Chikumbe.

Tobacco is also unhealthy for farmers, labourers and their families as well as factory workers who process it.

Dr William Maina from the WHO’s Africa Regional Office, points out that farmers have prolonged exposure to toxins in the chemicals used, and exposure to nicotine when picking the tobacco leaf.

“A tobacco farmer who plants, cultivates and harvests tobacco may absorb nicotine equivalent to 50 cigarettes per day,” said Maina.

Tobacco growing and manufacturing also threatens biodiversity, negatively impacts soil health by causing nutrient depletion and soil erosion which results in global deforestation and produces environmental harm such as toxic emissions, greenhouse gases and air pollution.

“Most of the tobacco-growing countries in Africa are suffering from food and nutritional deficiencies. However, most of the fertile and arable land has been put on tobacco growing instead of food production. Diverting prime land away from food production is contributing to world hunger.”

He suggests that countries whose economy relies on tobacco should assist their farmers to switch to alternative crops and other livelihoods that provide them with equivalent or higher returns compared to tobacco with reduced labour and exposure to health and environmental risks.

“Governments should stop providing direct tobacco subsidies to tobacco farming and reallocate these to tobacco control programmes including, where applicable, support to alternative livelihoods to tobacco programmes and agriculture extension services,” he advised.

Image Credits: Josephine Chinele.

In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis.

A massive 7.5 million people were diagnosed with tuberculosis in 2022, the highest number ever – but this is positive as it indicates that countries’ ability to detect the disease is recovering after the COVID-19 pandemic, according to the World Health Organization (WHO) 2023 Global tuberculosis (TB) report.

The two countries that contributed most to the global rebound in new diagnoses were India and Indonesia, together accounting for 56% of the increase between 2021 and 2022. They were followed by Philippines (11% of the global increase) and Pakistan (8.4%).

Meanwhile, an estimated 10.6 million people fell ill with TB in 2022 – 300,000 more than the previous year, with WHO’s South-East Asia Region (46%), Africa (23%) and the Western Pacific (18%) worst affected.

But the good news for those with TB is that treatment coverage has recovered to the pre-pandemic level of 70%, up from 62% in 2021.

Slight decrease in deaths

Dr Tereza Kasaeva, WHO’s Global TB Programme director,

TB was the second leading cause of death in 2022, beaten only by COVID-19 – despite being “completely preventable and curable”, said Dr Tereza Kasaeva, WHO’s Global TB Programme director, at the report’s launch on Tuesday.

“What is missing? Prioritisation and enough investment, as we have much better tools for successful treatment, even for the most severe forms of drug-resistant TB,” she added.

However, TB deaths were down to an estimated 1.3 million, in comparison to an estimated 1.4 million for 2020 and 2021, according to the report.

But the net reduction in deaths between 2015 to 2022 is only 19% – far from the WHO End TB Strategy milestone of a 75% reduction by 2025.

The WHO African and European regions have made the best progress in cutting deaths since 2015, while 47 countries have achieved reductions of at least 35%

Drug-resistant TB is a ‘public health crisis’

“Multidrug-resistant TB remains a public health crisis,” said Kasaeva, adding that only two out of five people with multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) received treatment last year.

With around 410,000 people developing drug-resistant TB in 2022, Kasaeva described drug-resistant TB as “stable” with “no  clear progress toward the decrease of the burden”.

“The cumulative reduction in the TB incidence rate from 2015 to 2022 was only 8.7%, far from the WHO TB strategy milestone of over 50% reduction by 2025.”

Some 42% of the global burden of people with drug-resistant TB comes from just three countries – India (27%), the Philippines (7.5%) and Russia (7.5%). 

“The uptake of the latest recommendations of the WHO for the shorter treatment option is not fast enough,” said Kasaeva. “That’s why we can’t celebrate any progress. It’s stable, it’s concerning and should be improved significantly.

On the positive side, almost three-quarters (73%) of people diagnosed with pulmonary TB were tested for rifampicin resistance, up from 69% in 2021. Some 4.4% were diagnosed with MDR/RR-TB.

The cumulative number of people with MDR/RR-TB on treatment from 2018 to 2022 was 825 000 – 55% of the 5-year target of 1.5 million. For children, the cumulative number was 21 600 – a dismal 19% of the five-year target of 115 000.

But the report notes that there have been “steady improvements in the treatment success rate for people diagnosed with MDR/ RR-TB”, although its latest figures are from 2020, when the treatment success rate was 63%.

“By the end of 2022, 40 countries had started to use the new six-month BPaLM/BPaL regimen to treat people with MDR/RR-TB or pre-XDR-TB. A total of 92 countries were using the shorter nine-month oral regimens for the treatment of MDR/RR-TB,” the report notes.

Price reductions

However, Medecins sans Frontieres (MSF) notes that price reductions for the TB test GeneXpert MTB/RIF Ultra, key to diagnose TB, and the drug bedaquiline, an essential part of the new shorter and safer DR-TB treatment regimens,  has made the scale-up of these medical tools “significantly more achievable”.  

In September, US corporation Cepheid reduced the price of the GeneXpert MTB/RIF Ultra test in high-TB-burden countries by 20% (from US$9.98 to $7.97). 

Meanwhile, Johnson & Johnson decided not to enforce its secondary patents for bedaquiline in 134 low-and middle-income  countries. J&J also granted Stop TB Partnership´s Global Drug Facility`s (GDF) a licence that enabled it to tender, procure, and supply generic versions of bedaquiline to most LMICs. 

The WHO first recommended the GeneXpert MTB/RIF as the initial test to diagnose TB in December 2010, and the shorter, safer and more effective all-oral six-month DR-TB treatment regimens BPaLM and BPaL in December 2022. 

“Although today’s TB statistics once again highlight how TB, a neglected but curable disease, keeps killing millions of people year after year, there may be light on the horizon,” said Dr Gabriella Ferlazzo, TB Medical Adviser of MSF’s Access Campaign.

“Over the last three months, we’ve witnessed a striking string of good news for TB, with long-fought price reductions finally coming through for better tests and drugs, and governments meeting at the UN [at the high-level meeting on TB in September] to promise to ramp up TB testing, treatment and prevention for their people, including children.”

The UN High-Level Meeting on TB set new targets for 2023-2027, including reaching 90% of people in need with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB, providing a health and social benefit package to all people with TB, ensuring the availability of at least one new TB vaccine and closing funding gaps for TB implementation and research by 2027.

Ferlazzo called on governments to “use the WHO-recommended tools and strategies we now have to diagnose and treat everyone who needs it, and to increase funding for TB research and care.” 

Stop TB Partnership Executive Director, Lucica Ditiu, paid tribute to all those who had managed to diagnose and treat the 7.5 million people with TB.

“Now that we have shown what can be done – can we get the financial resources and the political commitment so that we are done once and for all with this disease? It is a matter of choice for the governments, donors, and all of us,” she added.

‘Catastrophic’ out-of-pocket costs

Handaa Enkh-Amgalan, a TB survivor from Mongolia.

The report also notes that more than half of TB patients and their households face “catastrophic health costs”  – medical expenses as well as indirect costs, such as travel expenses to pick up their daily medicines, income loss, food supplements and the cost of carers. 

“These costs amount to greater than 20% of total household income,” said Handaa Enkh-Amgalan, a TB survivor from Mongolia.

“Twelve years ago, I was one of those statistics where my family and I were affected by the same level of financial burden of TB that we are seeing in this report. My mom and I faced a tough choice to make. It was down to either affording bread for me and my siblings or going to a TB clinic to have an X-ray done for diagnosis,” said Enkh-Amgalan.

“My mom was able to make the decision to head to a clinic. But there are many more people who are simply unable to make that decision. TB patients are often labelled and stigmatised as irresponsible or non-compliant. These catastrophic costs and stigma are two of the many barriers that are driving millions of patients away from seeking diagnosis and treatment.”

Lack of funds

It’s not only TB patients that are short of cash, however. The entire sector is under-funded despite the impact of the disease.

“Less than half of the $13 billion needed for TB prevention, diagnosis, treatment and care to achieve the global targets was mobilised,” said Kasaeva.

Around  80% of spending on TB services in 2022 came from domestic sources, yet “for low and middle income countries, international donor funding remains crucial”, she added.

The US contributes about 51% of international donor funding for TB and Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID), stressed her government’s “deepest commitment” to move forward on the UN targets.

Image Credits: Stop TB Partnership.

Saima Wazed (in black), along with her mother Bangladesh Prime Minister Sheikh Hasina, during an official visit to the United States to meet US President Joe Biden and First Lady Jill Biden. Wazed’s election as WHO-SEARO’s regional director has been dogged by allegations of nepotism, and her mother’s government is said to have relentlessly lobbied for her win.

Amidst a flurry of allegations of nepotism and political corruption, Saima Wazed, daughter of Bangladesh Prime Minister Sheikh Hasina, has emerged victorious in the race for the World Health Organization’s South-East Asia (WHO-SEARO) regional director.

Wazed’s limited international public health experience and expertise, confined to the narrow field of autism, have raised concerns among experts about her ability to effectively lead the region’s health agenda.

“It is a bit of an experiment to see if a non-public health qualified person with zero public health experience can actually provide the degree of inspiration that is needed to bring about significant shifts or strengthening public health policy,” Mukesh Kapila, a public health expert with experience working in 120 countries, told Health Policy Watch.

While acknowledging the possibility of improvements in the management and internal workings of WHO regional and country offices under Wazed’s leadership, Kapila remains sceptical.

“Can she improve the relevance, effectiveness and efficiency of the WHO in the region? Time will tell,” said Kapila.

Wazed’s dual Canadian citizenship has also drawn scrutiny, raising questions about potential conflicts of interest and her commitment to public health in Bangladesh and the wider South-East Asia region.

Politics wins over experience in WHO-SEARO backrooms 

Wazed’s victory is being attributed to a relentless campaign by her mother’s government, which mobilized its diplomatic network to secure her election. She will now be responsible for providing independent and impartial advice to Bangladesh from WHO.

“The fact [is] that professionals and staff, from my own conversations with them in SEARO, have no confidence in her,” said Kapila. “She’ll be trying her very best not to ruffle [them] too much as she will be trying to win them over. And that means she is unlikely to be much of a change agent.”

Her election opponent Shambhu Prasad Acharya is a veteran WHO official with three decades of experience with the UN health body. Acharya, who received immense support from Nepal’s civil society, was seen as a more qualified candidate but lacked support from other countries in the region.

Kapila attributed Acharya’s loss to Nepal’s position as a poor country that was unable to strike backroom deals to push its candidate, emphasizing that such tactics should not be necessary in the selection of WHO officials.

Of the 11 countries in the region, 10 were eligible to vote in a secret ballot, with Myanmar being disenfranchised because of the sanctions imposed on it. The Bangladesh High Commission shared that Wazed had received 8 out of the 10 votes.

Wazed will take charge in February next year and will be succeeding India’s Poonam Khetrapal Singh who has held the post for a decade now.

Outgoing WHO-SEARO Regional Director Dr Poonam Khetrapal Singh announced earlier this month that Bangladesh has become the world’s first country to eliminate visceral leishmaniasis.

The selection process of WHO’s regional offices has been in the news for a while now. In September, the medical journal The Lancet carried an editorial about the concerns about the candidate selection, and opacity of the election process. Wazed’s candidacy was also questioned on similar grounds.

Earlier this year WHO fired the regional director for the Western Pacific region on an enquiry into allegations of misconduct, as HPW reported in March this year.

Despite a quarter of the world’s population living in the SEARO region and the high number of COVID-19 deaths recorded during the pandemic, the SEARO office was hesitant to hold press conferences or provide regular updates on the situation. This contrasted with other WHO regional offices that were more proactive in communicating with the public.

Indian journalists faced difficulties in accessing accurate information about the country’s COVID-19 death toll at the height of the pandemic. The Indian government reportedly lobbied the WHO against releasing its excess deaths report, which would have revealed the country’s true death toll. The SEARO office remained largely silent on this matter, despite the significant public health implications.

Shenanigans in WHO South-East Asia as Politician’s Daughter Contests Regional Director Election

The region also has exceedingly high air pollution levels, an issue that WHO could get involved with more actively. Severe air pollution has once again engulfed Delhi, affecting health in the region. This year, cities like Mumbai with relatively clean air have also been hit hard.

While Singh was hesitant to take a stronger stand on the issue with the respective governments, Wazed is likely to follow suit, given how instrumental the Indian government’s support has been for her victory, experts HPW spoke to said.

“It was a victory not for global health or professionalism,” said Kapila. “It was a victory for state politics, and interstate politics and money and basically Bangladesh’s clout to get votes. But then I suppose that is politics for you.”

Experts also said that given Hasina’s government is in trouble in Bangladesh and Wazed is aware of her unpopularity within the WHO, she might not want to ruffle any feathers and is unlikely to take any strong policy stand.

Image Credits: X, WHO.

Al-Quds Hospital on 29 October.  WHO denounced weekend attacks around the hospital; Israel says Al Kuds and other facilities are being used by Hamas.

Gaza’s struggling health facilities were again caught in the crosshairs of the Israeli-Hamas conflict over the weekend, as Israel acknowledged it had attacked an ambulance that it claimed was ferrying Hamas gunmen out of Gaza City’s Shifa Hospital, and a dozen UN leaders called for an urgent cease fire. 

Israel pounded Gaza by air and on the ground over the weekend in what was reportedly amongst the heaviest days ever of bombardment. Hamas continued to fire missiles at Tel Aviv and other major Israeli cities in the center and south. Monday evening, news reports had fighting intensifying around Shifa Hospital, the largest hospital in Gaza, which has been identified by Israel as a major Hamas underground command and control center.

Meanwhile, Iranian-aligned Hezbollah forces in Lebanon claimed responsibility for a barrage of rocket attacks on northern Israeli cities, as far south as Haifa. 

”We need an immediate humanitarian ceasefire.  It’s been over 30 days,” said the heads of over a dozen UN agencies along with six NGOs in a joint appeal published on Monday. “Enough is enough. This must stop now.

In Israel, some 1,400 people have been killed and thousands have been injured, according to the Israeli authorities. More than 240 people, including children, have been taken hostage. Rockets continue to traumatise families. More than 200,000 people have been displaced.

“This is horrific,” stated the letter, signed by WHO’s Director General, Dr Tedros Adhanom Ghebreyesus, as well as the heads of UNICEF, UN Women and Care International. “However, the horrific killings of even more civilians in Gaza is an outrage, as is cutting off 2.2 million Palestinians from food, water, medicine, electricity and fuel.”

In Gaza, according to the Ministry of Health, nearly 9,500 people have been killed, including 3,900 children and over 2,400 women. More than 23,000 injured people require immediate treatment within overstretched hospitals.

Extensive destruction caused by the unprecedented level of Israeli airstrikes on Gaza since the 7 October Hamas incursion into Israel.

“An entire population is besieged and under attack, denied access to the essentials for survival, bombed in their homes, shelters, hospitals and places of worship,” stated the UN appeal. “This is unacceptable. More than 100 attacks against health care have been reported,” stated the letter, which also called for “the immediate and unconditional release of all civilians held hostage.”

Israeli ground troops have now encircled Gaza city on all sides – and are slowly advancing toward the city center, in a complex operation that they say is focused on rooting out and destroying from the air and the ground, the extensive underground tunnel network developed by Hamas over the past decade.  

On Monday, Israel’s military again urged the estimated 300,000 Palestinians still trapped in northern Gaza to flee south via Gaza’s Salahuddin Highway,  between 10-2 p.m. But the Gaza-based Health Ministry warned Palestinians against fleeing via the route, calling it a “death corridor.”

WHO protests attacks in the area of Gaza hospitals

On Sunday, WHO also condemned Israel’s attack on two ambulances as they tried to leave Shifa hospital, as well as attacks in the vicinity of two other major Gaza hospitals in the north of the enclave, Al-Quds and the Indonesian hospital. 

“According to reports, at Shifa Hospital, ambulances were evacuating critically injured and sick patients to hospitals in the south of the Gaza Strip,” said the WHO statement, “when there was an attack at the entrance of the hospital.

“According to early reports, at least 13 people were killed and more than 60 injured. The hospital infrastructure and one ambulance sustained damage. This was in addition to an earlier incident that had resulted in damage to another ambulance in the same convoy,” said the WHO statement. 

WHO also reported that “two further attacks were reported on the same day at Al-Quds hospital, resulting in 21 injuries, as well as near the Indonesian hospital,” noting that “attacks on health care.. may amount to a violation of international law.

Israel: Hamas systematically using hospitals and ambulances   

Aerial view of the Gaza’s Indonesian Hospital, with the outlines of what Israel says are military tunnels.

In a foreign press briefing Sunday, Israel’s military spokesperson Dan Hagari charged that the ambulances attacked by Israel were being used to transport Hamas gunmen. His briefing followed comments by senior US administration officials earlier in the week that Hamas had tried to sneak its fighters out of Gaza in ambulances taking seriously wounded to Egypt. 

“It’s a war crime,” he said, “that Hamas is using hospitals for military purposes.”

As for the hospitals, Hagari displayed aerial and satellite photographs of alleged Hamas’ operations in and around the Indonesian Hospital and Gaza’s Qatari-funded Sheikh Hamad bin Khalifa al-Thani Hospital. 

They included pictures of what Hagari said were tunnel entry points by the Qatari hospital, exposed by Israel’s forces in recent ground operations, as well a video of alleged Hamas shooting from the hospital grounds.  Parts of the hospital were also damaged in aerial raids, earlier in the month. 

At the Indonesian Hospital, Hagari displayed time series photos showing stacks of cement arches on the hospital grounds when the facility was being built in 2010, which he said laid the foundations for the tunnel network now buried under the facility. 

Israeli military spokesman Daniel Hagari points to cement arches that he says Hamas used to expand its tunnel network during the hospital’s 2010 construction.

“How Hamas uses hospitals to disguise the war machine is systematic,” he said.  “Cement arches are not needed when building hospitals. They are used to build an underground city of terror and underground metro tunnels. We have watched Hamas use these arches to build tunnels for many years.

“Instead of building homes for Gazans, Hamas built this metro over hundreds of kilometers underneath Gaza and underneath places like hospitals and mosques. 

Israel continues to rebuff reports of fuel shortages

Israel has also continued to rebuff humanitarian appeals for fuel to replenish what WHO says are severely depleted hospital supplies.  

“There is no shortage of fuel in Gaza,” Hagari declared at the briefing, playing what he said was a covertly recorded conversation between a Hamas operative and a Shifa Hospital administrator, about the movement of fuel supplies. 

“Hamas stores this fuel underneath hospitals in Gaza – the very hospitals that Hamas tells the world is running out of fuel,” he said.

On Sunday, Israel’s Ambassador to the UN in New York City shared a video of Shifa’s windows illuminated at night, along with outdoor spotlights, for what he said was a public screening by Hamas of a military video on the hospital grounds.   

“Hamas has plenty of fuel for whatever they choose to prioritize,” Erdan said. “If only ICU incubators were as important to Hamas ….” 

Hostages largely forgotten in the bitter conflict 

Sharon Cunio and her husband with their twin daughters, prior to being kidnapped by Hamas.

As the claims on both sides rage along with the bitter military conflict, the families of the estimated 241 hostages held by Hamas since 7 October  expressed growing desperation over the fate of their families, and the lack of attention the captives are receiving. 

“All around me I have witnessed a silence so enormous, it feels cacophonous;” wrote Alana Zeitchik, a New York City-based media professional of Yemenite-Israeli origins in the Sunday New York Times. 

Her cousin Sharon Cunio, husband David and their three-year old twins are being held captive along with Sharon’s sister and five-year-old daughter, since being snatched by Hamas gunmen from their bomb shelter on Kibbutz Nir Oz. Their plight, she said, is an issue which few in the humanitarian community have cared to address.  

“Again and again I hear that Israel is a country of white colonizers and oppressors,” she wrote in the Times. “Some of my bewilderment is in my very skin. My maternal grandparents, Avraham and Sara, grew up in a tiny rural village in central Yemen. Like other Jews in the Arabian Peninsula, Yemenite Jews were persecuted as second-class citizens… In 1949, after pogroms against Jews in Yemen, my grandparents set out by foot and donkey on an arduous journey to the capital, Sana. From there, they were airlifted during Operation Magic Carpet to the newly formed state of Israel. As refugees fleeing oppression in their birth country, they began their lives in Israel in poverty. Slowly they built a humble but comfortable life and raised five children, amongst them my mother.

So maybe you can imagine my surprise the first time I heard my Israeli family called “white colonizers.” When did we become white? And how could a family fleeing persecution be perceived as colonizers?

“It would appear they believe my suffering to be collateral damage in service of some universal truth they hold higher. Is it really impossible to hold these two truths at the same time — that both Israeli and Palestinian civilians are suffering at great cost?” she asked. 

Within Israel there is widespread sentiment that any cease-fire needs to be conditioned upon release of the hostages – who are being held in unknown locations, and without any access to the International Red Cross.

“Israel allowed humanitarian aid into Gaza, why aren’t our children getting the same?” asked Moran Alony, brother of Sharon, speaking on the sidelines of the UN Security Council in New York City late last month.

Image Credits: https://www.emro.who.int/media/news/hospitals-in-the-gaza-strip-at-a-breaking-point-warns-who.html  , WHO/EMRO , Times of Israel .

INB co-chairs Roland Driece (centre) and Precious Matsoso (right) at the seventh meeting of the intergovernmental negotiating body.

At the start of the seventh round of negotiations on a pandemic agreement on Monday, a number of European countries asserted that any changes to intellectual property (IP) rights should be thrashed out at the World Trade Organization (WTO) – not the World Health Organization (WHO). 

IP rights are one of the most controversial aspects of the pandemic agreement negotiations and, with a negotiating text finally before WHO member states, sharp disagreements were once again evident at the Monday plenary of the intergovernmental negotiating body (INB).

Describing the text as an “improvement”, the European Union nonetheless expressed concerns about clauses on IP, technology transfer and finance in the text.

Germany, Sweden, Ireland and the UK were more direct in their opposition to any attempts to undermine IP protection, stating that discussions belong at the WTO.

“Speaking as one of those Geneva ambassadors who has the good fortune to cover both the United Nations and the World Trade Organisation, I do need to reaffirm our conviction that the WTO is the appropriate forum to discuss our obligations on intellectual property,” said the UK representative.

US representative Colin McIff and Ambassador Pamela Hamamoto.

Meanwhile, the US stated that “eliminating intellectual property protections will not effectively improve equitable access during pandemic emergencies, and will in fact harm the systems that have served us well in the past. 

“The United States believes strongly in IP protections which serve to fuel investment and innovation. We agree that more timely access to these innovations should be central to our discussions and are exploring options to prioritise the availability of medical counter-measures for developing countries during future pandemic emergencies.”

Articles 10 (on sustainable production) and 11 (tech transfer and know-how) appear to be the thorns in their flesh. 

Article 10 simply “encourages” entities – particularly those that get significant public financing – to grant “non-exclusive, royalty-free licences to any manufacturers, particularly from developing countries, to use their intellectual property” to develop “pre-pandemic and pandemic diagnostics, vaccines and therapeutics”.

Article 11 is more explicit, committing parties during pandemics to “time-bound waivers of intellectual property rights to accelerate or scale up the manufacturing of pandemic-related products”.

During the stakeholder session, Knowledge Ecology International (KEI) described the text’s provisions on IP limitation as “well-intentioned but problematic”.

“Parties do not need to refer to the WTO TRIPS agreement or a waiver. Global rules on exceptions are broad enough. What is needed is the implementation of laws and use of exceptions at the national level, to address IP issues in a way that is useful,” said KEI.

KEI’s Thiru Balasubramaniam

WTO appeals for synergies

The WTO appealed for “synergies and complementarity” between its processes and bodies and the “trade-related elements of the INB’s draft negotiating text”.

These include consideration by the TRIPS Council of extending “to COVID-19 therapeutics and diagnostics the 2022 ministerial decision on the TRIPS Agreement”, discussions in the Council for Trading Goods on “export restrictions, regulatory requirements, international coordination, transparency, and trade facilitation”, and “mapping manufacturing capacities and demand” to develop a “global supply chain and logistics network”. 

Meanwhile, the World Intellectual Property Organization (WIPO) asserted that “any outcome from the INB process should not affect the rights and obligations and the other existing international agreements” and that “protection of IP rights is important for the development of new medical products”.

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that the parts of the current text would undermine the innovation ecosystem that enabled the pharmaceutical industry’s “ability to rapidly develop medical countermeasures”.

The IFPMA also warned of “unnecessary bureaucratic hurdles” that “will deter the scientific research”.

“The draft lacks a clear strategy for a robust procurement mechanism for low-income countries and fails to adequately address trade barriers that could hinder the global distribution of medical supplies,” added the IFPMA.

‘Common but differentiated responsibilities’

The Equity Group and Africa Group objected to the removal of common but differentiated responsibilities (CBDR) – a term usually used in climate talks to indicate that, while all countries have responsibilities, economic differences mean they cannot all have the same level of responsibilities. 

The Equity Group, which represents 29 countries across regions – including Brazil, China, South Africa and Pakistan – stated that CBDR is important for “international solidarity and inclusivity”. 

“CBDR should be included in the treaty with a view to achieving equity and attaining the highest standard of health for all,” said South Africa for the Equity Group.

South Africa’s Ambassador Mxolisi Nkosi on behalf of the Equity Group

The group “has developed textual proposals to be included in the draft negotiating texts that will lead to the realisation of equity as a central mandate”, noted South Africa.

The group wants stronger equity language in eight sections: Article Seven (health and care workforce), Article Nine (research and development), Article 10 (sustainable production), Article 11 (technology transfer), Article 12 (access and benefit sharing), Article 13 (supply chain and logistics), Article 19 (implementation support) and Article 20 (financing). 

The Africa Group also appealed for health sector strengthening to include a prohibition on wealthy countries poaching health workers from poorer countries.

Lack of gender equity

Last week, Medecins sans Frontieres (MSF) noted that “there is no reference to sexual and reproductive rights services in the text, “gender equity” has been deleted from general principles, and “gender inequalities” is only mentioned in the articles on health workforce and international cooperation and collaboration.

The Pandemic Action Network (PAN) also raised the text’s failure to include “gender equity language for persons in vulnerable situations”. 

“Equity and human rights must explicitly include gender. Parties must agree to collect and report gender-disaggregated data, uphold social protections and protect the full spectrum of essential health services for all emergencies,” said PAN. 

The Office of the High Commissioner for Human Rights also noted the lack of references to gender and human rights (three mentions each).

Meanwhile, the Independent Panel on Pandemic Preparedness and Response called for “definitive, results-oriented language” that commits countries to invest in building regional resilience by defined dates. 

Modalities still undecided

There was widespread member state support for the start of “direct negotiations” focused on the most important aspects of the draft – which is now being referred to as an “agreement” – rather than the more legally binding accord or treaty.

However, there was also some support for the continuation of informal meetings to address contentious articles – particularly during the month-long break between the first part of this INB meeting this week and its second session on 4-6 December.

Ethiopia’s Ambassador Tsegab Kebebew on behalf of the Africa Group

However, Ethiopia on behalf of the Africa Group, rejected the informal meetings as a “parallel process”.

The Africa and Equity Groups, as well as countries from the Americas, want to start with the most contentious part of the draft, Chapter Two which covers equity.

The INB co-chairs appealed for member states not to repeat their well-known positions “twenty months into negotiations”, but to move forward to find consensus.

The US also “urged consideration of industry and stakeholder views, which will be essential for the future implementation of this agreement”. 

“This outreach needs to be done with greater intensity given these partnerships will provide important information about the viability of many proposals in that text,” said the US.

Japan also requested dialogue with “relevant stakeholders, including research institutes, industry, and civil society”, particularly with “entities which will be involved in the implementation of this draft agreement”.

Israel-Palestine conflict clouds discussion

The Israeli-Palestinian conflict cast a long shadow over the INB meeting, with a number of countries stating their support of one or the other during their comments on the draft. The most tense exchange came from representatives of the territories.

“A pandemic situation is in front of our doors in Palestine as the sewage pumping system is not operational any more,” warned the representative from Palestine.

Palestine appealed for international assistance, including “air-tight body bags, help with extracting bodies, as well as trucks and bulldozers, medicines, medical equipment and, “the most urgent, water, food and fuel for hospitals, ambulances and health care access in general”.

“No place is safe in the occupied Palestinian territory – the West Bank including East Jerusalem and the Gaza Strip,” he concluded, noting that over 9000 Palestinians had been killed in the month-long conflict.

However, Israel’s representative accused the Palestinian Authority of giving “a free pass to a genocidal terrorist organisation which unleashed its terror on Israel people on October 7”.  

“It’s certainly perplexing that the delegation does not condemn the action of Hamas when on October 7, they committed the slaughter of Jewish people, not for anything they have done, but because of who they were. 

“When Hamas entered southern Israel and slaughtered, raped, tortured and murdered 1400 people, they were civilians,” noted Israel’s delegate, calling on Palestine to “condemn Hamas for using the Palestinians as humans shields and for “the slaughter of 1400 people on October 7,” he concluded.

The INB co-chairs allowed comments on the conflict but conceded at the close of the meeting that this had slowed progress and that Tuesday’s meeting would still need to decide on the modalities for negotiations.

Snakebite is a complex and neglected issue that requires a multifactorial strategy, including conservation, community engagement, scientific research and robust healthcare delivery, according to experts who recently participated in a Global Health Matters podcast.

In the most recent episode of Global Health Matters, host Garry Aslanyan speaks with Fan Hui Wen and Thea Litschka-Koen, snakebite gurus in Brazil and Eswatini, who reveal untold truths about snake bites in their communities and the complexities associated with producing and administering antivenom. He also talks with Diogo Martins, the research lead for snakebite at Wellcome in the United Kingdom.

How big is the snakebite challenge?

The World Health Organization estimates that 5.4 million people are bitten by snakes every year, and nearly 140,000 people die.

“The burden is quite big,” Martins says, explaining that of the 5 million people who are bitten each year, 2 to 2.5 million are venomous bites. “We’re talking about 100,000 deaths every year, and this is most likely an underestimation. And four times more of that will live for the rest of their lives with, unfortunately, amputations PTSD and that’s a huge burden.

“And we’ve done a little bit of desk research about how that compares with many other popular global health issues, and it’s actually quite a substantial amount of years lived with disability, and it’s quite expressive that people just do not know much about it because it feels a little bit remote to many of us, unfortunately,” Martins says.

How can we treat snakebites?

While antivenom is the best treatment for a venomous snakebite, many complexities are associated with producing and administering antivenom, the experts explain. In addition, according to Litschka-Koen, a lot of clinicians have no faith in antivenom, in part because of the ineffectiveness of the antivenoms that are currently on the market.

“There is no regulation regarding the effectiveness of the antivenom,” Litschka-Koen, founder and chairperson of the Eswatini Antivenom Foundation, says. “To produce antivenom is not difficult. To go through the pre-clinical trials it is incredibly costly.

“I had no idea how difficult and costly and cumbersome it was actually to produce this product. If it does happen, it needs to be very well regulated,” she continues. “It needs to go through the processes, and it needs to be monitored. Otherwise, we’re going to go back 10 years, and we’re going to be in the situation again where the doctors say, what’s the point of using antivenom? It doesn’t work.”

She says that countries can and should start producing their antivenom. However, if they do not, then good antivenoms need to be made accessible. Currently, many antivenoms carry a high price tag, making them out of reach for many people living in low- or middle-income societies.

“It’s inconceivable that … you can have patients having patients having to pay $100 in many geographies to solve one episode of a snakebite,” Martins notes. “We cannot have individuals that earn $1.50 a day and have the unfortunate circumstance of crossing paths with a venomous snake, and suddenly all of their savings are gone, not to even mention other impacts socially and economically.”

Listen to more episodes of Global Health Matters here.

Image Credits: TDR/Global Health Matters.

Same place two months apart. Above: AQI 78, 8th of September, 2023, below: AQI 479, 3rd November, 2023

Within hours, the Delhi government closed schools and announced traffic and construction curbs, but experts are questioning whether the government is tackling the right causes. Meanwhile, a database reporting the contribution of pollution from farm fires has been discontinued by the national government. The air quality forecast remains bleak.

Delhi’s air pollution suddenly got a whole lot worse on the 2nd of November, hitting the government’s own defined ‘severe’ levels of 379.2 micrograms/m3 of PM2.5 for the 24-hour period. 

Despite rising levels of awareness and preparedness for air pollution emergencies, the deterioration in air quality was not anticipated by the Air Quality Early Warning System run by the Central government. 

Unlike in years past,  officials both at the national and Delhi state level were quick to respond – reflecting the growing awareness of air pollution’s health harms over the past few years. 

Within hours, Delhi’s Chief Minister Arvind Kejriwal closed primary schools, and the national government launched an 8-point plan to curb pollution emissions, including a system of ‘differential’ fares for public transit to encourage off-peak bus travel. 

But despite the measures the latest forecast shows the next few days may continue to see severe air pollution or at best ‘very poor.’ This translates into pollution levels that are roughly eight times the WHO 24-hour average guideline standard for PM2.5 levels, widely regarded as the best indicator of health-harmful pollutants. 

And the immediate outlook remains bleak. ‘Severe or Very Poor’ air quality is forecast for six days starting on the 3rd of November. 

Stubble burning may, or may not, be the leading factor 

Delhi’s haze of 2nd November, 2023: The barely visible building is about 700 metres away, when the hourly PM 2.5 level in this location was a little over 450 micrograms/cubic metre (µg/m3). The WHO’s safe limit for a day is 15 µg/m3.

While many have cited the stubble burning by farmers in rural states north of Delhi, as a key driver for seasonally high levels of pollution in the late fall and early winter, local sources may also be playing a larger role in the leading factor in the current emergency, experts said. 

The fact is that this year, the number of stubble fires burning in Punjab, the state that produces the lion’s share, had declined by about half their seasonal rate, as of the 1st of November. 

In their quest for sources, some experts were now pointing squarely at Delhi and surrounding cities – where cooking from biomass, traffic and industrial emissions may now be the leading factors. 

Additionally, there are the classic weather conditions faced by Delhi at this time of year, when falling temperatures, low wind speeds and a lack of rainfall all trap pollutants closer to the ground. Confounding the issues, one leading government data source on air pollution sources, maintained by the System of Air Quality and Weather Forecasting and Research (SAFAR), has been discontinued, making it more difficult to attribute the sources of pollution at all.

Living in a Haze

On Thursday, the usual morning haze lingered on and appeared to get worse as the day wore on. Visibility fell, and many people complained of sore throats, running noses and fever. Social media was buzzing with pictures and complaints demanding to know how this is allowed to happen year after year. 

Preliminary data shows that levels of PM 2.5, fine particulates that are the most common indicator for health risks, shot up beyond 250 micrograms/cubic metre (µg/m3) on average across India’s capital around 2-3 p.m. Thursday afternoon. That’s 17 times greater than WHO’s 24-hour standard of just 15 (µg/m3) . 

The mid-afternoon spike was also unusual. As it’s the hottest part of the day, pollutants tend to rise with the heat thereby reducing ground-level pollution. 

The pollution emergency was not forecast although satellites and at least one supercomputer are now being used in India to track air quality.

Eight-point graded response plan announced 

The main body in charge of controlling pollution in and around Delhi, the Commission for Air Quality Management (CAQM) blamed meteorological and climate conditions as “highly unfavourable.” The air quality index (AQI) was only expected to worsen in the coming days, it also warned.

As the AQI hit ‘severe’ it triggered multiple responses. Government officials gave the go-ahead for an 8-point action plan – under a programme called Graded Response Action Plan (GRAP). 

Topping the list is more vacuuming and mechanised sweeping of roads and sprinkling water to suppress dust. 

The government also introduced differential rates on Delhi’s public transport system to encourage off-peak travel to reduce traffic congestion.

Bus frequency has also been increased and special shuttles are being started for central government employees, a senior official of the Government of Delhi, Mr Ashish Kundra told Health Policy Watch. 

The Committee also announced a  ban on all construction and demolition projects except for essential hospitals, defence, metro and other infrastructure. 

They announced restrictions on the movement of older vehicles that fail to meet the latest pollution standards within Delhi and four bordering cities (Gurgugram, Faridabad, Ghaziabad and Gautam Budh Nagar a.k.a. Noida.)

Officials Divided: To Walk Or Not To Walk

But there appear to be cracks in the air pollution control system. It goes beyond the well-publicised discussion around a basic shortage of staff. 

In the first 24 hours of the crisis, there’s been contradictory health advice to residents from two top agencies. 

Notably, the CAQM, controlled by the Central government, says those in Delhi and its neighbourhood should “walk or use cycles for short distances.” SAFAR, also controlled by the Central government (they have the said supercomputer), says “everyone” should avoid all physical activity outdoors and “give a miss to walk today.”

Scientists have documented how even short-term exposure to hazardous levels of PM 2.5 are linked to premature mortality, increased emergency room visits and hospital admissions for acute and chronic cardiovascular and respiratory conditions.  As a result they have generally recommended restricting outdoor physical activity on high-pollution days.

Focusing on the wrong pollutants? 

A look at the curbs announced by the CAQM also shows that there is an emphasis on controlling construction and road dust. 

However, the contribution of these sources to Delhi’s current air pollution problem is very marginal, according to daily source attribution data generated by the Ministry of Earth Sciences. 

Known as the Decision Support System for Air Quality Management in Delhi (DSS). This is the one India-based reference point remaining for unraveling air pollution sources following the discontinuation of the SAFAR database.

For 2 November, the DSS showed Delhi’s construction as contributing  2% of ambient air pollution, while road dust and waste burning contributed just 1% each. 

In contrast, the largest proportion of pollution currently was from biomass burning – 25% according to the DSS database. This latter presumably includes the thousands of crop stubble farm fires burning up north in the states of Punjab and Haryana – but it also could include local household sources of heating and cooking. 

Delhi-area transport accounted for about 14%. Meanwhile, another 30% of emissions are transported into the city from 19 nearby towns. 

Another 16% of emissions originate from areas beyond the Delhi region – although there is no further detail on the types of sources here, as well. 

Notably, more precise data on the source apportionment of farm fires used to be provided by the SAFAR database, operated by the Centre’s Ministry of Earth Science, until only a year ago and cancelled for reasons that no one has managed to explain. 

Given a dearth of information about sources, then, major questions remain about how effective are the measures being taken in Delhi in the current air pollution crisis. 

Farm Fires vs Delhi’s Own Pollution

Satellite data shows that the number of farm fires in the north Indian state of Punjab has sharply declined compared to a year ago, but have begun to rise now. Source: CEEW.

Many farmers burn the residual stubble from the paddy harvest in order to sow the next crop, largely wheat, by mid-November. It’s the most economical way specially for marginal farmers to do so given how expensive manual labour or machines are. 

The governing party of Punjab, Aam Aadmi Party (AAP) is also in power in Delhi. It had promised to reduce the number of farm fires by half this year; last year there were almost 50,000. The data so far shows that that seems to be on track. The fire count till the 1st of November, i.e. a day before the air quality turned ‘severe’, was under 9,000 compared to over 17,000 a year ago at the same time.

However, the fires are rising daily. The four-day average till 1st November was 2,200 compared to under 900 a week earlier. The number of fires is expected to rise till mid-November when the wheat must be sowed. 

The smoke appears to be smothering Delhi. While the DSS data showed it was contributing a quarter of the pollution, the EU space programme posted that a “thick smoke blanket (from the stubble fires in the northwestern states) is engulfing” the capital.

Additionally, the CAQM stated that there was a sudden increase in the number of farm fires, combined with unfavourable meteorological conditions (low wind speed) moving pollution to Delhi. 

However, some experts point out that the lower number of farm fires underscores a greater truth. 

“The contribution from fires or any sources will continue to remain debated as there is not a clear consensus on the emissions inventory being used to develop these models” for source attribution. 

“Despite lower levels of burning in the same period this year (vis-à-vis) last year, we see that the AQ is as bad, if not worse than last year, and this points to the other sources that exist within the NCR that need better coordination to address. 

“In two weeks’ time, we will have to shift focus to those more persistent sources that pollute our air throughout the year. The role of meteorology must be discounted at all times- what we cannot control, we cannot obsess over and blame. We can only bring down our emissions,” says Karthik Ganesan, Fellow, Council on Energy, Environment and Water (CEEW.)