Prof Hassan Shehata, president of the Royal College of Obstetricians and Gynaecologists, Dr Hannah Nazri, Asia Network to end FGM/C and Anna af Ugglas, chief executive of the International Confederation of Midwives.

CAPE TOWN – More and more health workers are performing female genital mutilation (FGM) in South and South East Asia – although the process is internationally recognised as a serious human rights violation with no medical justification. 

Health professional associations mulled over how to ensure that health workers stop performing this harmful practice at the World Congress of Gynaecology and Obstetrics (FIGO) in Cape Town on Wednesday.

Growing “medicalisation” has been observed in Brunei, India, Indonesia, Malaysia, Pakistan, Singapore, Sri Lanka, and Thailand, according to a new report released at the FIGO congress.

Around 80 million women and girls have experienced FGM or cutting (FGM/C) in the region, which entails procedures that involve partial or total removal of external female genitalia, or other injury to the female genital organs for non-medical reasons. 

Of the eight countries, only Indonesia explicitly bans the performance of FGM, including by healthcare professionals, according to the report, which was compiled by Equality Now, the Asian-Pacific Resource and Research Centre for Women (ARROW), Orchid Project, and the Asia Network to End FGM/C.

Despite this ban, implemented in 2024, almost half of all procedures in Indonesia are now done by trained midwives, often as part of maternity packages.

In Malaysia, doctors are the primary providers, and 85.4% of the doctors interviewed in a 2020 study said that female genital cutting should continue. 

In Singapore, almost half the women interviewed in a 2020 study had been cut by doctors. In Sri Lanka, FGM is increasingly being performed by physicians in private clinics, with services being advertised on social media, according to a 2025 report.

“FGM is being offered in government hospitals in Brunei, which indicates government support,” according to Equality Now’s Julie Thekkudan.

In Thailand, there is a rise in girls undergoing FGM/C in health facilities, with doctors disclosing that they perform 10 to 20 procedures monthly. 

‘Regulation of sexual desires’

The motivation for cutting women’s and girls’ genitalia is rooted in cultural and religious beliefs – primarily that it will prevent promiscuity. 

It is also often performed on babies and young girls before they reach puberty, subjecting them to intense pain as the area is dense with nerve fibres and blood vessels, added Nazri.

In the Gambia, 70% of girls have undergone FGM by the age of nine, while in Malaysia, it is most commonly performed on infants and pre-school girls. 

“If you have to perform a harmful procedure to regulate a person’s sexual desires, there is something very wrong,” said Dr Hannah Nazri from the Asia Network to End FGM/C.

“If people want to prevent their daughters from being promiscuous, then they should educate them,” she said, adding that parents should not be able to give consent on behalf of their daughters for a procedure that would cause permanent harm.

Nazri, who also represents Malaysian Doctors for Women and Children, added that human sexuality is a complex process that is rooted in reactions in the brain as well as the body, so damaging a woman’s genitals will not remove her sexual desire.

Dr Hannah Nazri

Medicalising does not reduce harm

There is no evidence that the use of health workers reduced the harm. Instead, some studies found that healthcare professionals were more likely to conduct more severe forms of the procedure than traditional practitioners, using their anatomical knowledge and anaesthesia, which often resulted in deeper, more extensive cuts.

“Medicalisation of FGM/C does not make the practice safe. On the contrary, it risks embedding it within health systems, undermining medical ethics, and exposing women and girls to long-term physical and psychological harm,” said ARROW’s Safiya Riyaz.

“Medicalising FGM/C may be intended to reduce harm, but it does not make the practice safe,” she added. “With medicalisation rising across Asia, healthcare professionals are in a unique position to protect women and girls. They must be supported by clear laws, accountability, and cultural change to end this harmful practice.”

Role of professional bodies

The World Health Organization (WHO) strongly urges health workers not to perform FGM and has developed a global strategy to support the health sector and health workers to end FGM medicalisation, which is practised in 94 countries.

Dr Christina Pallito, WHO lead on harmful practices, said that the global body’s guidances on the issue are aimed at “shifting values, shifting beliefs and to change the behaviours, to bring more health workers to be against medical FGM and understand why they should not do it”.

Anna af Ugglas, chief executive of the International Confederation of Midwives (ICM) which has over one million members, said that her organisation believes FGM is a “harmful cultural practice that should never be performed”.

She called for closer alignment between health professionals to stop FGM/C.

While she advocated for a “stick and carrot” approach to stop health workers from performing the procedures, “there must be consequences for harm”, she added.

Professor Hassan Shehata, president of the Royal College of Obstetrians and Gynaecologists (RCOG), said that 44,000 women and girls died each year from FGM: “That’s one every 12 minutes.”

The RCOG, which has members across the world, makes it clear that FGM/C is a human rights abuse and has clear guidelines for its members, said Shehata.

“We have embarked on a lot of work about FGM in Africa, and [run] a training course where we address three main issues: One, advocacy; Two, training that FGM has no place, whether it’s medically, religiously or socially. Three for members to understand the complexities and implications of FGM – mental health, sexual health, physiology, obstetrics, and gynaecology.”

Nazri believes educating health workers is more effective than banning FGM: “A lot of health workers are not aware that FGM is a human rights violation. The law is silent about it in Malaysia and often junior doctors don’t want to go against their seniors, so a legal framework would help and also allow doctors to educate their patients.”

Equality Now’s Thekkudan said there was low awareness of the harms of FGM/C and there need to be “national awareness campaigns” that include the medical fraternity.

The procedure is not taught in medical schools, and health workers learnt how to perform it from older health workers and traditional birth attendants, she added.

International development aid is still prioritising fossil fuel-based energy projects while funding for clean air initiatives fell sharply in 2023, according to a new Clean Air Fund Report.

Development funding for fossil fuel-based energy projects jumped 80 per cent in 2023 to $9.5bn, up from $5.3bn in 2022, even as toxic air causes more than 8m premature deaths annually, according to a new report.

Governments continue to channel billions more in international aid into projects that prolong fossil fuel use than into tackling air pollution, the Clean Air Fund found. Direct support for outdoor air quality initiatives fell 20 per cent to $3.7bn, representing just 1 per cent of all international development financing, according to the organisation’s annual State of Global Air Quality Funding report released Wednesday.

However, total international development aid for clean energy projects with air quality co-benefits reached $32.6 billion in 2023, nearly 3.5 times fossil fuel investments — a marginal increase from $31.8 billion in 2022.

“Air pollution is a public health emergency hiding in plain sight,” said Jane Burston, chief executive of Clean Air Fund. “Every year, toxic air kills more people than tobacco — contributing to 8.1 million deaths — yet governments are still funnelling billions into the fuels that cause it.”

Beyond international aid budgets, national fossil fuel subsidies from governments totalled $7 trillion globally in 2022, equivalent to 7.1% of global GDP, according to International Monetary Fund data. That represents 1,400 times more than what flows to clean air projects, even as roughly 85% of global air pollution stems from burning fossil fuels and biomass.

“You can’t build healthy societies on dirty air,” Burston added. “When aid money props up fossil fuels instead of cleaning our air, it’s not just bad for the planet — it’s deadly for people.”

Total air quality funding, including clean energy projects, as a proportion of international development aid, 2019-2023.

The scale of the mismatch has prompted calls for a fundamental reorientation of development finance. World Bank research shows that integrated air quality and climate policies could save more than 2 million lives annually by 2040 while boosting global GDP by up to $2.4 trillion each year.

As funding continues flowing towards fossil fuels, the report calls for development institutions to go in the opposite direction: embed clean air objectives at the core of climate and development finance, redirect fossil fuel funding toward cleaner transitions and target resources toward currently underfunded regions, particularly Africa.

The findings come as governments face pressure to deliver on a pledge made earlier this year at the World Health Organization’s World Health Assembly to halve the health impacts of anthropogenic air pollution by 2040.

Air pollution ranks as the world’s second-largest health risk factor after high blood pressure, claiming over 8 million lives annually. Fine particulate matter known as PM2.5 — particles smaller than 2.5 micrometres — penetrates deep into the lungs and bloodstream, damaging the cardiovascular system, triggering strokes and heart attacks, and contributing to dementia, cancer and respiratory disease.

Total air quality funding compared to fossil fuel funding as a share of international development finance, 2019-2023.

The WHA resolution marks the first time air quality has been included in a WHO roadmap with a clear global health target tied to pollution reduction. Under South Africa’s G20 presidency, air quality was also elevated as a standalone priority for the first time in the G20’s environment and climate workstream.

But with the Trump administration having axed the vast majority of USAID, which contributed 29 per cent of official development assistance in 2023 – by far the largest single provider of aid in the world, supporting everything from infectious disease prevention to food security programmes – development budgets are under strain globally.

Wider cuts by OECD donors could see development aid fall by 9 to 17%, with least developed countries facing declines of 13 to 25%, respectively. Air pollution, already a relatively minor component of global aid budgets, representing just 1 per cent of international development funding, risks falling by the wayside. Experts warn that momentum risks stalling before meaningful progress can be made.

“Governments pledged to halve air pollution harm by 2040, but the money is still flowing the wrong way, Burston said. “With budgets already under pressure and the world’s largest development donor shutting down, we cannot afford to keep bankrolling fossil fuels. Unless we change course, millions more people will die from toxic air. Every dollar spent on fossil fuels pushes that goal further out of reach.” 

Most polluted regions are left behind

The ten most polluted countries for air quality, according to the Air Quality Life Index.

The limited funding available for air quality is highly geographically concentrated. Three countries — the Philippines, Bangladesh and China — received 65 per cent of all outdoor air quality finance between 2019 and 2023, while regions bearing the heaviest pollution burdens received almost nothing.

Nine in ten air pollution deaths occur in low and middle-income countries, where resources to respond are most limited. The World Bank projects deaths from outdoor air pollution will rise from 5.7 million in 2020 to 6.2 million by 2040 without stronger action. 

Sub-Saharan Africa experienced a 91% collapse in outdoor air quality funding in 2023, dropping to just $11.8m — less than 1 per cent of global clean air support and roughly equivalent to the cost of a single superyacht. The staggering drop occurred as the region faces the world’s fastest urbanisation rate, leaving communities increasingly vulnerable to worsening air pollution.

Seven of the ten countries with the highest air pollution levels received less than $1 per person in total air quality financing in 2023. Countries including Cameroon, the Democratic Republic of Congo and Burundi received as little as $0.02 per person.

“Air pollution is the world’s largest environmental health crisis, yet it receives neither the attention nor the resources it demands. Each year, eight million people die prematurely from a crisis that is largely preventable. Today, nine in ten of these deaths occur in lowand middle-income countries,” Dr Dion George, South Africa’s minister of forestry, fisheries and the environment, wrote in the report’s foreword. “Without urgent action, this tragic toll will continue to rise.”

Air quality funding by type and sector, 2019-2023.

Children face particularly severe impacts. Air pollution causes over 700,000 deaths annually in children under five, making it the second leading risk factor for child mortality worldwide after malnutrition. Air pollution is also linked to 34 per cent of preterm births globally, with 570,000 neonatal deaths attributed to pollution exposure in 2021. 

“What we see currently is not so good – the availability of data from public actors is poor, and when available, the level of finance directed to improve air quality is far too low,” said Barbara Buchner, global managing director of Climate Policy Initiative, which co-authored the report. “But our work confirms that the opportunities are tremendous. With public budgets constrained, increasing air quality finance is one the most impactful investments that can achieve multiple goals: to address climate change, strengthen economies, and significantly improve daily life for millions globally.”

The economic burden is also crushing. World Bank analyses place global health damage costs at $8.1tn annually, equivalent to 6.1 per cent of global GDP. Lower-middle-income countries bear losses equivalent to 9 per cent of GDP compared to 2.8 per cent in high-income nations. India alone loses $95bn annually from reduced productivity, work absences and premature deaths, while China spends $44bn annually on healthcare for PM2.5-related illness.

In 2023, development funders committed 2.5 times more to fossil fuel-prolonging activities than to outdoor air quality improvements. The tension between energy access and air quality poses particular challenges for developing countries. While fossil fuel projects may offer faster paths to expanding electricity access, they lock in polluting infrastructure that carries severe long-term health costs.

Outdoor air quality funding as a share of total international development commitments, 2019-2023.

“Financing remains a major barrier to progress,” George wrote. “The evidence in this report is stark. In 2023, outdoor air quality funding fell by a fifth, even as the health burden grew.”

Funding for projects with air quality co-benefits — initiatives that improve air quality without explicit objectives to do so — rose 7% from $27.1 billion in 2022 to $28.8 billion in 2023. Examples include electric vehicle incentive programmes and projects that promote alternatives to crop residue burning.

Between 2019 and 2023, 86% of total air quality funding was directed towards projects that also addressed climate change, the report found. Transport sector investments attracted 61% of outdoor air quality funding during this period.

In the Greater Beijing-Tianjin-Hebei Region, coordinated action supported by the World Bank, Asian Development Bank and KfW reduced annual average PM2.5 concentrations by 44.2% from 2015 baseline levels by 2030, showing policy action is possible and effective.

“We know how to fix this,” Burston said. “Clean air policies deliver results within months — healthier lungs and fewer deaths. The science is clear, the technology exists, and the health benefits are immediate.”

Image Credits: Pete Markham.

Newborns are susceptible to malaria but there has been no treatment specially for them until recently.

Ghana is the first country in the world to roll out a malaria treatment specially formulated for newborn babies.

The new treatment, known as Coartem <5 kg Baby, uses a new ratio and dose of artemether-lumefantrine to account for metabolic differences in babies under 5kg. Small babies handle drugs differently due to the immaturity of their metabolising organs

The treatment received regulatory approval in Ghana in February and was also approved by the Swiss agency for therapeutic products, Swissmedic, in July.

Three-quarters of those who die from malaria are children under the age of five. Until now, babies under 4.5 kg with malaria were given formulations designed for older children, which increased either the risk of overdose and toxicity or underdose and treatment failure.

Coartem Baby was developed by Novartis, with support from the Medicines for Malaria Venture (MMV). It was tested in a trial known as CALINA, which was conducted in eight African countries with support from the PAMAfrica consortium, which is funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2).

“These tiny patients handle drugs differently due to the immaturity of their metabolising organs, which can lead to overdose and toxicity. Coartem <5 kg Baby provides optimised dosing specifically tailored to the needs of these vulnerable patients,” according to Novartis in a media release, following the successful conclusion of the CALINA trial.

“Infants under 5 kg can be affected by placental malaria, leading to poor birth outcomes, or contract malaria from the bite of an infected mosquito. The prevalence of the disease in this age and weight group is poorly understood, and it is therefore often misdiagnosed.

“Infants below 5 kg make up a critical neglected group, and developing antimalarials specifically suited to their needs is essential to malaria control efforts,” added Novartis.

Protecting the most vulnerable

“Malaria remains one of the deadliest diseases for children under five years old, and Ghana’s leadership in approving Coartem Baby is a powerful step toward protecting the most vulnerable,” said MMV CEO Dr Martin Fitchet

“This optimised formulation offers a well-tolerated and effective solution to a long-standing unmet medical need.”

Ghana is one of 11 African countries designated by WHO as High Burden to High Impact for malaria. 

About 30 million babies are born in malaria-risk areas in Africa every year, and a large survey across three West African countries reported infections in babies under six months old ranging from 3.4% to as high as 18.4%.

Novartis has committed to introducing Coartem Baby on a largely not-for-profit basis.

This week, Mali recruited the first pregnant woman infected with malaria into a Phase 3 trial that is evaluating the efficacy and safety of antimalarial drugs during the first trimester of pregnancy.

MMV is also supporting this trial, known as SAFIRE,which will compare the safety and efficacy of pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DP), both approved for the general population but not yet in early pregnancy, to artemether-lumefantrine (AL), which is approved by the WHO for use in the first trimester.

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

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

Image Credits: UNICEF/Zahara Abdul 2019.

Tobacco use is waning worldwide.

There has been a significant global reduction in smoking, but use remains stubbornly high in some countries and groups – while the tobacco industry is aggressively marketing new nicotine products to young people.

This is according to the World Health Organization (WHO) tobacco trends report, which was released on Monday.

“In 2000, one in three adults in the world used tobacco. By 2010, it was one in four. Today, in 2025, it’s fewer than one in five,” Jeremy Farrar, WHO’s Assistant Director General, told a media briefing.

“That means millions of premature deaths have been, and will be, averted,” he added, crediting “stronger policies, better awareness and the extraordinary efforts of individuals, governments, civil society and communities” for the progress.

South East Asia has achieved the most progress, with tobacco use in men almost halving from 70% in 2000 to 37% in 2024. In this region, India and Nepal have made good progress.

Tobacco use trends (2000-2030)

However, despite progress, the world is 3% short of achieving a 30% reduction in tobacco use between 2010 and 2025 (Sustainable Development Goal 3).

Slightly less than a third of the world – 61 countries, including 24 in Africa – are likely to achieve this target.

Three regions – Eastern Mediterranean (19% reduction), Europe (19%) and the Western Pacific (12%) – are also going to miss the target.

However, women already met the 30% target five years early in 2020.

“Most countries that are on track have something in common,” Farrar noted. “They all implement the WHO Framework Convention on Tobacco Control, and they put MPower measures in place, raising taxes, banning advertising, protecting people from smoke and warning of the harms and providing help for those to quit.”

MPower refers to the measures the WHO recommends to countries to reduce tobacco use.

“Nearly 20% of adults still use tobacco and nicotine products. We cannot let up now,” said Farrar. “The world has made gains, but stronger, faster action is the only way to beat the tobacco epidemic.”

Jeremy Farrar, WHO Assistant Director-General.

Progress lagging in Europe and men 

Europe has the highest prevalence in the world, with 24.1% of its adults using tobacco in 2024. Countries in the Balkans and former Soviet republics have the highest rates.

In Bulgaria, almost 36% of people smoke, the highest in Europe.

Some 17.4% of European women smoke, which is more than double the current global average of 6.6% (down from 11% in 2010).

Alison Commar, WHO technical officer and lead author of the report, said that only one Western European country, the Netherlands, has implementing MPower, the full WHO anti-tobacco suite of policies.

“They are really having success bringing down prevalence,” Commar added. In 2010, almost 28% of Dutch people smoked, whereas 20% currently smoke.

“Many of the European countries rely on the EU [Tobacco Products] Directive, which we call the minimal floor,” Commar added.

Alison Commar, WHO technical officer and lead author of the report

“Women in Europe have been using tobacco products a lot longer than women in other areas,” she added, explaining that the industry had “heavily advertised” cigarettes in the women’s movement in the early 1900s.

“So the use has really begun from then, and the normalisation as well. People have grown up with their mothers and their grandmothers smoking.” 

In the Western Pacific Region, some 43.3% of men smoke – the highest prevalence in the world. Indonesia has the highest rate in the region (30.2%), followed by China (22.7%), while a mere 8% of Australians smoke.

Globally, smoking is highest in men aged 45 to 54 and women aged 55 to 64. Men in upper-middle countries smoke the most – some 39%.

Over 40 million adolescents are reported to smoke cigarettes (26 million boys), with the Western Pacific Region having the highest prevalence of teen smokers.

“The tobacco and nicotine industries are deliberately targeting the next generation with new and many times under-regulated products. We cannot allow this to continue and to succeed,” said Farrar.

New nicotine products

Smokeless tobacco use

For the first time, WHO report estimated global e-cigarette use, finding that more than 100 million people worldwide are now vaping – some 7% of the world’s population.

Around 86 million adults, mostly in high-income countries, and 15 million children aged 13–15, already use e-cigarettes. 

Use is by far the highest in the Southeast Asia region, averaging 21.1%. The second-highest region is the  Eastern Mediterranean (4.9%).

Among the 85 countries with data on e-cigarettes, the highest use was reported in Serbia (18.4%), Luxembourg (17%), New Zealand (14%), Croatia (12%), Ireland (11.2%), Czechia (11.1%) and Brunei (11%).

In all but six countries, more teens vaped than adults.

More teens are likely to vape than adults, fuelling nicotine addiction, according to the WHO.

“In countries with data, children are on average nine times more likely than adults to vape,” according to the WHO, which accused the tobacco industry of “introducing an incessant chain of new products and technologies” to market tobacco addiction, including “e-cigarettes, nicotine pouches, and heated tobacco products”.

“E-cigarettes are fuelling a new wave of nicotine addiction,” said Etienne Krug, WHO Director of Health Determinants, Promotion and Prevention. 

“They are marketed as harm reduction but, in reality, are hooking kids on nicotine earlier and risk undermining decades of progress.” 

Comma said that the science is “now showing that [e-cigarettes] are very much a gateway for the young people to move later into tobacco or to maintain a nicotine addiction as they grow older”.

“WHO recommends that all countries regulate e-cigarettes immediately,” she added.

The report, which is produced every two years, derives most of its data from national surveys.

Image Credits: PAHO, WHO, WHO.

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

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

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

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

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

$10 billion to rebuild shattered health system 

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

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

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

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

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

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

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

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

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

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

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

Famine, unsanitary living conditions 

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

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

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

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

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

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

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

Israelis focused on hostages and 7 October legacy 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Confronting a dark narrative

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

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

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

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

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

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

Palestinian urges public to probe Hamas crimes alongside those of Israel

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

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

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

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

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

High stakes brinkmanship

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘More equitable’

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

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

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

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

Fill ethical gap

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

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

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

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

Image Credits: WHO.

A pregnant woman gets examined by a nurse.

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

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

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

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

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

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

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

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

Fast, feasible and effective

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

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

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

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

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

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

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

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

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

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

More evidence and protocols

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

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

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

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

Image Credits: Elizabeth Poll/MMV.

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

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

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

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

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

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

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

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

What works on the ground?

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

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

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

Watch the full episode: 

Image Credits: Global Health Matters.

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

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

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

Listen to the full episode:

 

Image Credits: "Trailblazers with Garry".

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

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

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

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

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

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

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

The Global Fund replenishment is decisive

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

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

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

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

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

Strengthening domestic resource mobilisation

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

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

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

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

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

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

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

Leveraging World Bank financing 

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

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

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

Where should UN focus?

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

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

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

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

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

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

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

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