Al Aksa Hospital, the largest hospital in central Gaza, overwhelmed by casualties as fighting between Israel and Hamas in area intensifies.

Médecins Sans Frontières (MSF) and two other international relief agencies all said that they are withdrawing emergency medical teams from Al Aqsa Martyrs Hospital in central Gaza after intensified fighting around the hospital area made it impossible for staff to continue emergency care functions. 

“After days of artillery fighting in Gaza’s Middle Area, Israeli forces dropped flyers with evacuation orders in the neighborhoods around Al-Aqsa Hospital,” said MSF in a statement on Saturday. “Over the last couple of days, drone attacks and sniper fire were just a few hundred meters from the hospital, and yesterday, a bullet penetrated a wall in the ICU.” 

On Sunday, two other relief agencies, the International Rescue Committee and the UK-based Medical Aid for Palestinians said that their Emergency Medical Teams also had been “forced to withdraw and cease activities” from the hospital in Deir Al Balah, which remains the only functioning hospital in Gaza’s “Middle” area. 

Speaking Sunday from Al Aqsa Hospital, WHO’s Sean Casey, WHO EMT Coordinator, described chaotic scenes where doctors struggled to provide trauma care to people who had been victims of bombardment and explosions. 

“The hospital is operating with about 30% of the staff that it had just a few days ago,” Casey said. “They are seeing hundreds of casualties in a small emergency department. They are treating children on the floor. The hospital director spoke to us, and his one request was that this hospital be protected, that they not be evacuated, that they are able to continue functioning,” Casey said. 

Meanwhile, a planned WHO mission to Al Awda Hospital in northern Gaza was cancelled Sunday for the fourth time since 26 December, “because we did not receive deconfliction and safety guarantees,” according to WHO’s Jerusalem-based Office for the Occupied Palestinian Territory on X (formerly Twitter). 

“The mission planned to move urgently needed medical supplies to sustain the operations of five hospitals in the north, including Al-Awda, said WHO. “It has now been 12 days since we were last able to reach northern Gaza. Heavy bombardment, movement restrictions, and interrupted communications are making it nearly impossible to deliver medical supplies regularly and safely across Gaza, particularly in the north.

Lacking adequate access, staff and supplies, doctors are being forced to perform more amputations on people who were unable to reach medical care, and now have severely infected limbs, Dr. Mohamed Obied, an orthopedic specialist at the hospital was quoted as saying. “And doctors are forced to amputate limbs more frequently, performing “above the knee, rather than below-knee amputations.”

Gaza amputee – above knee amputations becoming more frequent Palestinian doctors say.

Last Thursday, WHO’s Director General Dr Tedros Adhanom Ghebreyesus also deplored an Israeli attack on a Palestinian Red Crescent training center inside the Al Amal Hospital Complex in Khan Younis city in Southern Gaza, which reportedly killed five civilians including a newborn.  Some 14,000 displaced people are sheltering on the hospital grounds, Tedros noted.  

Growing hunger and risk of famine 

Nareman Abu Al-Soud, holds her newborn in the shelter of an IDP camp in Rafah, after fleeing her home during Israeli-Hamas fighting in Gaza.

Along with the conflict, per se, the growing specter of extreme hunger, and looming famine, are amongst the other risks faced by Gaza Palestinians in the new year, said the UN’s Martin Griffiths, in a statement on Friday.

A fresh report by UN Secretary General to the UN Security Council further warned that “widespread famine looms”. More than half a million people, a quarter of the population face extreme hunger, stated the bleak summary, published on X by Al Jazeera’s UN corespondent ahead of its formal release.

“People are facing the highest level of food security ever recorded… famine is around the corner,” echoed Griffiths, UN Under-Secretary General for Humanitarian Affairs and Emergency Relief Coordinator, also writing on X.   

Bereft of food, shelter and warmth, the conditions for disease spread are also ripe, he underlined.

“Families are sleeping in the open as temperatures plummet.  Areas where civilians were told to relocate for their safety have come under bombardment…  

“A public health disaster is unfolding. Infectious diseases are spreading in overcrowded shelters as sewers spill over, he added. “The humanitarian community has been left with the impossible mission of supporting more than 2 million people, even as its own staff are being killed and displaced, as communication blackouts continue, as roads are damaged and convoys are shot at. 

“Meanwhile, rocket attacks on Israel continue, more than 120  people are still held hostage in Gaza, tensions in the West Bank are boiling, and the specter of further regional spillover of the war is looming dangerously close. Hope has never been more elusive… We continue to demand an immediate end to the war.” 

Displaced people walk from the north of Gaza towards the south, as ambulances head in the other direction.

Israel under international pressure

Israel has come under increasingly intense international pressure, including charges of genocide, for its conduct during its invasion of Gaza, which began after Hamas gunmen entered some 22 Israeli communities around Gaza in the early morning hours of 7 October, killing 1200 people, mostly civilians, in their homes. 

Israel’s has since killed some 22,000 Palestinians, displaced 80% of the area’s 2 million residents, and turned northern Gaza City into an apocalyptic landscape of sand, rubble and blown out buildings during one of the most intense aerial bombing campaigns in history.   

After claiming “operational control” last week of most of northern Gaza, Israel’s military has now moved into central and southern areas of the densely-populated enclave, which is only 365 square kilometres in all, waging fierce battles there against Hamas fighters who are bunkered down in underground tunnels and still holding over 100 Israeli hostages, including the elderly, women and children. 

Speaking to the Times of Israel, the Israeli military spokesman said Hamas “systematically operates in the hospitals in the Gaza Strip and in the areas adjacent to them, using the residents as human shields and exploiting the hospital’s infrastructure, including electricity and water.”  

“Entire neighborhoods in the Gaza Strip have been converted into “fighting complexes” for Hamas, which include “ambushes, command and control apartments, weapon depots, combat tunnels, observation posts, firing positions, booby-trapped homes and explosives in the streets,” another Israeli military source was quoted as saying. 

Although Shifa’s hospital’s alleged Hamas underground “command and control” complex did not turn out to be as massive as Israeli military analysts originally had projected, significant evidence about Hamas military infrastructure under and around Gazan hospitals has been gathered and presented by Israel during the war. Several groups of Israeli hostages, mainly women and children, were also held in Gaza hospitals during part of their captivity, according to testimony by former Israeli hostages released in late November during a brief humanitarian pause and prisoner exchange.  

Image Credits: Democracynow.org, WHO , WHO , © UNRWA/Ashraf Amra.

Krakow skyline. Eight of the European Union’s 10 most polluted cities are in Poland. But an initiative to swap out polluting coal and wood furnaces/boilers could change that.

An ambitious Polish state policy that aims to replace 50% of the country’s coal and wood household furnaces/boilers with electric heat pumps or natural gas could dramatically improve air quality in a country with some of the worst ambient air pollution levels in the European Union, says a new assessment by the European Clean Air Centre (ECAC). 

The policy could save 21,247 lives a year in Poland, increase the number of people breathing clean air 15-fold, and help Poland reach new, and much stricter, EU air quality standards, according to the assessment, published in late December. New EU standards aim to align more closely with WHO clean air guidelines for PM2.5, the most health hazardous pollutant, with negotiations underway now about a timeline for implementation.  

The Polish national programme involves replacing half the country’s 2.7 million wood and coal-fired heating systems with natural gas furnaces or even more efficient heat pumps by 2030 – a rate of about 6000 weekly. 

Polish example may show a way to move faster

Today, only about 2 million Poles live in areas with PM2.5 air pollution levels of 10 micrograms/m3 or less – the envisioned EU air quality standard for 2030.
By 2030 nearly 30 million people would live in areas that meet the new EU air quality guidelines, if retrofits continue at the current rate.

The European Commission has proposed rules by which countries would need to meet a new PM2.5 target for ambient air pollution of 10 micrograms/m3 annually by 2030. That’s half of the current EU limit of 20 μg/m3 –  although at 5 μg/m3, the WHO guideline is even stricter. But some member states still have questioned the feasibility of the 2030 deadline to meet the new EU Air Quality Directive.

Yet, results from an assessment of Poland’s experience demonstrate that reaching the new standard on a tight schedule is feasible, even in nations with higher levels of air pollution, says the ECAC. 

Air pollution is the number one environmental health risk in the WHO’s 53-member European region, according to the World Health Organization. In 2019 alone, it accounted for 569 000 premature deaths. In the 27-member state European Union, the European Environent Agency (EEA) estimates that about 300,000 people die prematurely from air pollution-related conditions – including over 40,000 in Poland.

According to the EEA, eight out of ten most air-polluted EU cities are located in Poland. A key pollution source, to quote the Polish-language version of the ECAC report, is single-family houses using biomass and low-quality coal for heating.  Nearly 90% of Europe’s coal for household heating is burned in Poland.

For the past ten years, the sector has received much attention from legislators on local and country level. A decade of civil society activism in Kraków led the region to become the first in banning polluting coal furnaces/boilers. In 2019 a national programme subsidizing retrofits with modern electric systems was launched – and the results are potentially transformational.

“Poland’s coal boiler replacement programme is an example of what ambitious environmental policy can mean for normal people. Our analysis shows that 2.7 million households will replace their heating source and with refurbishment of buildings, this will lead to a more secure, cheaper and cleaner energy source across the country, a triple win.” Łukasz Adamkiewicz, ECAC’s lead researcher, told Health Policy Watch.

Ambient air pollution’s health effects

According to the WHO, tiny particles of PM2.5 or smaller penetrate deep into lung tissue, also entering the bloodstream and infiltrating into almost every organ of the body, causing systemic inflammation and carcinogenicity. Worldwide, between one-third and one-quarter of premature deaths involving heart attack, stroke, respiratory diseases, and cancers are attributable to air pollution. 

Right now, approximately 41 000 people die prematurely every year in Poland, as a result of ambient air pollution exposures.  Experts also note that the estimate is probably under-valued insofar as poor air quality has many indirect health effects, especially for more vulnerable populations such as children, pregnant women and the elderly. With European society aging, the health burden of pollution is likely to grow even more.

More efficiency, less CO2 emissions

Furnace retrofits would also reduce CO2 emissions from the household sector by 33% by 2030, the ECAC study estimates

Along with reducing air pollution, the revolution in heating sources also will have an impact on greenhouse gas emissions – reducing CO2 emissions from the household sector by 33%, the ECAC study projects.

While some households have replaced coal furnaces with gas boilers, heat pumps so far have comprised 50-60% of the retrofits. Both represent a significant reduction in CO2 emissions, insofar as gas is much more efficient and releases far less CO2 that coal when burned.

Heat pumps are even better, achieving efficiency rates three-to four times that of other heating systems, according to the MIT Technology Review. This means the heat they produce is three-to-four times the electricity used. 

Additionally, heat pumps can, and are, being integrated with rooftop solar panels amongst some households in Poland with support from other state and national subsidy programmes. When a rooftop solar array powers the heat pump during daytime hours, this reduces further demand on coal power plant generation – traditionally Poland’s dominant electric power source.   

Growing share of renewables in the Polish energy mix. From left to right: share of electricity sources through time (grey – coal; blue – natural gas; green – renewable sources) and renewable energy production in TWh (yellow – photovoltaics, blue – wind green – biomass, brown – bio gas, grey – water).

Thanks to the gradual shift, more than a quarter of electricity produced in Poland now comes from renewable sources. According to the European Network of Transmission System Operators for Electricity data, PV solar panels produced a record 17% of the country’s energy in July 2023.

That said, solar panel systems are still too expensive for many households and in many areas. And in many areas, the uptake of PV panels has already outstripped the capacity of the power grid to absorb the power thus generated.  This leaves further growth in the solar sector uncertain until the new Polish government sets a policy direction, said Adamkiewicz.

Continued subsidies essential to implementing the initiative 

The continuation of state-sponsored subsidies for furnace/boiler conversions is critical to maintaining the current pace of change; the subsidies are projected to support about 87% of the heating system modernisations over the coming years, the ECAC report notes.

Luckily for air quality, Poland’s new climate minister, Paulina Hennig-Kloska, plans on sustaining the subsidy programme, which is investing a total of €25 billion into the clean heating system retrofits.

Additionally, electricity tariffs need to be made more affordable and attractive so as to encourage consumers to move to more efficient heat pumps, as compared to gas, researchers and activists state. 

“When compared with gas, the replacement with heat pumps has dropped from 60% in 2020 to 48% now as a share of the types of boilers being replaced, said Adamkiewicz. “A further decline will occur if the government does not prepare a special tariff and other regulations,” he warned. 

Poland sets example in the midst of trilogue negotiations

The Polish policy trends come at a crucial time for the EU Parliament.  The proposed EU Air Quality Directive (AAQD) is not only more rigorous in terms of air quality standards, it also would introduce an option for citizens to go to court over the health effects of excessive air pollution.

The final shape of the new Directive is currently under discussion between the European Commission, the European Council and the European Parliament in complex “trilogue” negotiations to hone down details of the new rules. As Parliament has already voted in favour of sweeping revisions, it is now up to the Council, which includes representation from all member state governments, to make the next step.

“Trilogue negotiations between the Commission, Council and Parliament are ongoing, and the legislation needs to be finalised by mid-February in order to become law before the European Parliament elections,” noted the ECAC in a press release.

Some member states in eastern and souther Europe have pushed back against the new EU rules saying that countries with a GDP below the EU average need a ten year time frame for  implementing the stricter air quality standard, rather than six years, as is now proposed. But Poland’s example shows faster implementation of clean air policies isn’t necessarily linked to income levels. 

“Poland should be seen as an example of what can be done in Europe with the right policy in place,” states Adamkiewicz.

Image Credits: Zuzanna Stawiska , ECAC , Wysokie Napięcie.

Village pharmacy in Kaga Bandoro, Central African Republic; weak drug regulatory systems still leave the door open to substandard and fake medicines in many countries.

CAIRO, Egypt -Some 70% of countries globally have weak national medicines regulatory systems. But the launch of the African Medicines Agency should help address many of the shortcomings on the African continent, said speakers at the 6th Scientific Conference on Medicines Regulation in Africa (SCoMRA), convened here in mid-December. 

The conference, organized by the African Union Development Agency-NEPAD (AUDA-NEPAD) in partnership with the World Health Organization (WHO) and the African Medicines Regulatory Harmonization programme (AMRH) examined how stronger regulatory systems can increase equitable access to life-saving medicines.

“Since its inception we can say SCoMRA over the years has been instrumental in strengthening Africa’s harmonization efforts by promoting the regulation of medical products and propelling the continent towards equitable access to lifesaving medicines,” said WHO’s Andrea Keyter, reflecting on the theme of this year’s event.

Andrea Keyter, WHO Department of Prequalification and Regulation

Despite progress made, leadership changes, sustainable financing, human resource constraints, and infrastructure deficiencies, remain key challenges, said Keyter, a technical officer in WHO’s Department of Prequalification and Regulation.  

She referred to a 2021 WHO survey published in the Global Benchmarking Tool for Evaluation of National Regulatory Systems of Medical Products that found 70% of countries worldwide with weak national  regulatory systems for health products.

“There is the need for a more efficient use of the global regulatory resources to facilitate access to quality-assured medical products and to build capacity,” Keyter emphasized 

Battling Substandard and Falsified Medical Products

Wanga Karim, Kenya Pharmacy and Poisons Board

In another WHO report cited by Wanga Karim,  head of post market surveillance at the Kenyan Pharmacy and Poisons Board, substandard and falsified (SF) medicines are on the market in every country. At least one out of 10 tested samples in low- and middle-income countries are substandard or fake.

Unfortunately, public health officials in many countries fail to appreciate the burden of SF medicines. As this is better understood, officials will be able to make more informed choices about investments in regulatory systems that watchdog medicines quality.

On the persistent challenges of substandard and falsified medical products in Africa, Karim called for a concerted effort in utilizing available resources to curb the problems of SF on the continent.  

WHO describes substandard and fake medicines as medical products that have not undergone evaluation and /or regulatory approval for the market in which they are marketed, distributed, or used.

Increase in the marketing of contaminated cough syrups

WHO alert on 5 October 2022 of contamination found in four Indian-made cough syrups consumed by children in The Gambia – some of whom later died.

In particular, the number of reported incidents of contaminated cough syrups has increased over the last 3 years, Karim said, noting. “Contaminated syrups have been detected in all regions – with exception of the WHO Region of the America.” As of Oct 2023, the highest number of reports of such incidents was in the African Region. 

According to Karim, some  22 incidents of cough syrup contamination with the chemicals diethylene glycol and ethylene glycol (DEG/EG) were reported to WHO in 18 member states involving 58 unique product batches between 2020 and 2023. Senegal, The Gambia, India and Cambodia topped the list.

In The Gambia, one of the biggest cases, DEG/EG contamination was “potentially” linked with acute kidney injury and 66 deaths among affected children, WHO Director General Dr Tedros Adhanom Ghebreyesus in October 2022.  Subsequent WHO-commissioned laboratory tests confirmed the presence of DEG/EG in four cough syrup products. The Haryana-based Maiden pharmaceuticals plant, which produced the syrups, was shut down temporarily by the Indian government as a result, while other products were recalled.  

In the period 2014 – 2023, Eritrea received about 2,400 alerts of suspected substandard or fake products, ultimately recalling more than 100, said Mulugeta Russom of the Eritrean Pharmacovigilance Centre, who presented a report on understanding, readiness and response in combating falsified medicine products in the country. 

“FS is a global threat because weak regulation and harmonization is a fertile ground for falsification hence in combating falsified medical products, understanding, knowledge and the political will is needed,” he concluded. 

International collaboration is critical 

Dr Tamer Essam, chair Egyptian Drug Authority, at the 6th Biennial Scientific Conference on Medical Products Regulation in Africa

Conference participants stressed the importance of international collaboration in the fight against substandard and fake products. 

“Unity in action is our strongest asset,” said AUDA-NEPAD’s Chimwemwe Chamdimba.   

Tamer Essam, Chairman of the Egyptian Drug Authority, highlighted the significance of improving the local legal frameworks and strengthening intersectional collaboration on the continent to maximize resources for the fight. “Improving the legal framework and strengthening intersectional collaboration are essential steps to combat SFMP effectively. We need a unified front in this battle,” he added.

Hiti Baran Sillon, a unit head in WHO’s Department of Regulation and Prequalification emphasized the crucial role of data and information sharing in the fight against fake and substandard medicines. 

“Enhancing data and information sharing on SF medical products among member states is crucial,” he said, adding, “collaboration is our strongest weapon against this menace.” 

African Medicines Agency – still waiting to begin operations

(Left-right) WHO’s Hiiti Baran Sillon, Dr Magareth Ndomondo-Sigonda, NEPAD; and Adam Mitangu Fimbo Vice Chair of the AMRH Steering Committee at the 6th Biennial Scientific Conference on Medicines Regulation in Africa.

The African Medicines Agency is expected to help intensify the fight against fake medicines – expediting the sharing of data and information between countries, participants stressed. 

Some 55 countries have signed and/or ratified  the AMA Treaty, with Tanzania as the most recent, ratifying the treaty on 31 October 2023.” 

Aimed at facilitating sustained continental-wide harmonization of technical standards and processes, the AMA Treaty, which came into force in November 2021, was built on earlier AMRH efforts in regulatory harmonization. 

The AMA is expected to further support countries in  assessing complex medical products, provide scientific and regulatory advice in support of local pharma industry development, and expedite the removal of unnecessary technical barriers to trade in pharmaceuticals.

In June, the African Union signed an agreement with Rwanda to host the new AMA. The search for a director is meanwhile reportedly underway. But there has so far been no firm date fixed for the AMA to actually begin operations. Meanwhile three of Africa’s most powerful nations – Nigeria, South Africa and Ethiopia, have yet to sign the AMA treaty.  

The AMA is positioned not to replace but to coordinate and complement the work of national regulatory authorities and regional economic communities, stressed  Keyter.  However, in order to advance progress in regulatory strengthening, the importance of collaboration cannot be underestimated, she stressed. 

Dr David Mukanga, chair of AMRH, at the 6th Biennial Scientific Conference on Medical Products Regulation in Africa

Conference participants also  highlighted the significant role of the African Medicines Regulatory Harmonization (AMRH) initiative, in the lead-up to the AMA’s creation. Said David Mukanga, chair of ARMRH Partnership Platform, “AMRH has been instrumental in implementing the African Vaccines Regulatory Forum (AVAREF) and the African Medicines Quality Forum (AMQF)  and has contributed to improved regulatory decisions, reduced registration timelines, and enhanced regulatory capacity.”

Image Credits: Jessica Ahedor , DIFD , Jessica Ahedor, AUDA/NEPAD, World Health Organization .

Extinction Rebellion protest in London on 9 April 2022.

In early December, I was one of the nearly 100,000 delegates at COP28, the biggest climate conference ever held. As a senior health professional and campaigner for gender equity in health, I was pleased to see the adoption of the first ever COP health declaration.

Who among us can still deny that climate change is a direct threat to human health? Ours is an age when humanitarian disasters as a result of wildfires, flooding, heatwaves and hurricanes have become the norm. The WHO tells us that 3.6 billion people already live in areas highly susceptible to climate change. That’s nearly half of us humans. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from undernutrition, malaria, diarrhoea and heat stress alone. We know that women and children are 14 times more likely to die as a result of a disaster than men and that women and girls are more likely to be malnourished than men and boys, so it is clear that climate risks are not equally shared.

Women and girls among the hardest hit by dual climate and health crisis

Water security
Women and children spend 200 million hours every day collecting water – an increasingly scarce resource in regions stricken by more climate-induced droughts.

Women and girls are part of the vulnerable populations hardest hit by the dual climate – health crisis. Together they represent 20 million of the 26 million people estimated to have been displaced already by climate change. Because of poverty, detrimental social and cultural norms and other such factors, they often come last in accessing vital health services. The numbers are so stark, it seems almost redundant to highlight that this is a deeply gendered injustice.

The tight link between climate, health and gender doesn’t stop here, however. The overwhelming majority of people dealing with the impacts of climate disasters within health services everywhere are – you guessed it – women.

Women make up 70% of the health workforce and 90% of frontline health workers during crisis situations, such as natural disasters or the COVID-19 pandemic. They are the ones who tend to bear the brunt of huge disruption, keeping health systems afloat – and saving lives. As we have seen in the pandemic, they work the extra shifts, put their own health at risk and do what’s needed to keep everyone safe in times of high risk  and hardship.

This alone is nothing if not commendable. But that’s not all.

Women also on frontlines of healthcare crisis

Women health workers profest protest about poor working conditions during the COVID pandemic.

In keeping all of us safe, women health workers themselves are forced to accept unsafe working conditions. Often, they don’t have basic personal protective equipment (PPE). Our own Women in Global Health research during the pandemic, documented stories of women nurses or doctors having to fashion themselves aprons out of garbage bags, or to reuse PPE because of insufficient supplies. To make matters worse, when PPE is provided, it often doesn’t fit women – and therefore doesn’t protect them, because it was made to fit a male body, which is used as the standard.

And to make their jobs and lives even more stressful, women health workers routinely experience abuse, sexual violence and harassment from male colleagues, patients and community members. This only gets worse in times of crisis. During the pandemic, for instance, women frontline workers were targeted with abuse in some contexts, wrongly accused of spreading infection and later by anti-vaccination campaigners.

This might all be different if women health workers were equally included in health systems’ decision-making. Although they represent the large majority of the health workforce, women occupy only 25% of leadership positions. In January 2020, just five women were invited to join the 21-member WHO Emergency Committee. A 2020 Women in Global Health Study found 85% of 115 national COVID-19 task forces had majority male membership. It’s high time we recognise this is not only unfair and obscenely disproportionate – but it has a cost as described in our new report ‘The Great Resignation’, which details the growing global trend of women health workers leaving, or planning to leave, the profession. And we cannot be surprised that women are leaving the health sector in alarming numbers.

Gender equity is not just a ‘nice-to-have’

When it comes to the humanitarian impacts of the climate crisis, all of this matters. Women are the first to respond during a climate-induced natural disaster, from the health frontline, but also as carers of their families and their communities. Climate change is amplifying and multiplying health emergencies.  Gender equity is not just a ‘nice-to-have’ in the face of such unpredictability, it is fundamental to all our survival. When we depend on women to keep us safe and minimise the human toll of climate unpredictability, we can’t afford to let them down.

This is why, as glad as I am – as a health professional – to see a first-ever health declaration adopted at COP28, and knowing – as a former government official of Pakistan – what painstaking negotiation is needed for any international agreement, I know we need to go much further, much faster, for the predominantly female health workforce upon whom we depend in climate unpredictability. The health declaration mentions health workers as well as women and girls only once, when they must be central to our thinking and our interventions around the climate-health intersection. Anything short of a new social contract for women in health, equity in leadership and gender transformative approaches across our health system means we risk not being able to withstand the challenges that unpredictable climate events are throwing at us. Anything less than genuine commitment and action is, frankly, hot air that we cannot afford.

Dr Shabnum Sarfraz

Dr. Shabnum Sarfraz is the Global Director for Gender and Health and Deputy Executive Director of Women in Global Health.  Before joining Women in Global Health, Dr. Sarfraz previously served at the Federal Planning Commission, Government of Pakistan, including leading Pakistan’s national COVID19 response efforts and served as the national focal person for SDGs. 

Image Credits: Roberto Barcellona, Shutterstock, UNICEF, Women in Global Health .

Dengue Chikungunya Zika
Aedes aegypti mosquito on skin.

Incidence of dengue virus has soared in 2023 to near historically high levels, the World Health Organization (WHO) reported on Friday, with more than 5 million cases worldwide and 5,000 deaths from the virus that still lacks an effective treatment or vaccine.

Moreover, formerly dengue-free countries in southern Europe, such as France, Italy and Spain reported local transmission of dengue virus, in what may be a first for Europe.

“Usually, Europe reports imported cases from the Americas, from the Western Pacific, from the endemic regions,” said WHO’s Dr. Diana Rojas Alvarez, speaking at a UN press briefing Friday morning. “But this year we saw limited clusters of autochthonous transmission. As we know, the summers are getting warmer.”

Another growing concern is the fact that dengue outbreaks are occurring in fragile and conflict-affected countries in the eastern Mediterranean region such as Afghanistan, Pakistan, Sudan, Somalia and Yemen.

Close to 80% of dengue cases, however, continue to be reported in the Americas, with the highest proportion of cases in the Caribbean, followed by Brazil and Mexico.  The disease is also prevalent in most of Southeast Asia and the Western Pacific region, reported Alvarez.

Climate change a key factor

Warming temperatures have become a leading driver in the increase of dengue transmission, particularly in tropical and sub-tropical climates but also extending at times to more temperate zones such as southern Europe, she stressed.

“Climate change has an impact in dengue transmission because it increases rainfall, humidity and temperature,” said Dr. Alvarez. “These mosquitoes are very sensitive to temperature.”

Transmitted by the Aedes Aegypti mosquito, dengue virus is one of the most widespread vector borne diseases.  Originally harboured by mosquitoes in rural and forested zones, it has also become a major threat in burgeoning urban areas of the global south – where mosquitoes breed in home water containers as well as in the rainwater accumulating in discarded tires and other refuse.

While there is no specific treatment, early diagnosis and supportive care can reduces risks of death.  Although most people recover within a couple of weeks, those who have been affected by dengue in the past can become more ill upon re-infection with a second or third bout of the virus.  The onset of severe dengue infections can occur even after initial fever has subsided and be accompanied by symptoms such as bleeding gums, stomach pain, vomiting, liver enlargement, leading to severe bleeding or organ impairment, according to WHO.

The 2023 El Niño phenomenon, which has exacerbated the effects of global warming, and along with that, increased rainfall, is another factor in the growing prevalence of the disease, WHO said.

Controlling vector spread

 

Aedes aegypti lay their eggs in containers such as bottles, tires, fountains, barrels, and pots.

Along with southern Europe, the disease is being seen with increased frequency in southern areas of North America and Latin American countries such as Uruguay as well as mountain areas of Colombia and other regions more than 2000 meters above sea level, where the mosquito previously didn’t thrive.  In Africa, 15 countries have reported outbreaks this year, mostly in West Africa, but also Chad and Ethiopia.  In the Middle East and South Asia, high levels of rainfall have increased mosquito densities, and consequent risks, in countries such as Bangladesh, Oman and Saudi Arabia.

Adding to the risks are the already wide distribution of the A. Aegypti mosquito vector – including in Europe.

Mosquitofish (Gambusia affinis) can be placed in decorative ponds and other large container habitats to prey on mosquito larvae and effectively prevent mosquito development.

Key interventions for prevention and control include: strengthening surveillance and reporting of cases; and strengthened vector control activities to reduce mosquito breeding grounds, and thus densities, WHO said.  and  density of mosquitoes; and reinforcing risk communications and community engagement.  Poor water and sanitation and unsafe waste management adds to dengue risks.

In Southeast Asia and the Americas, successful dengue control has often involved community-level identification and bio-control of sites where the mosquitoes breed, including the introduction of harmless predators, including locally-available species of fish  or crustaceans that feed on the mosquito larvae, into water reservoirs and water containers.

Image Credits: James Gathany/ PHIL, CDC, Public Domain, © 2011 Nature Education .

The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana. Now a second vaccine, R21/Matrix-M has been added to WHO’s recommended procurement lists.

The World Health Organization (WHO) has added the R21/Matrix-M malaria vaccine to its list of ‘prequalified’ vaccines, paving the way for bulk procurement and mass deployment of the new vaccine across malaria-endemic countries by UNICEF and other global health agencies.

The prequalification of the world’s second malaria vaccine, developed by Oxford University and manufactured by Serum Institute of India (SII), is expected to greatly expand access to malaria vaccination, particularly in malaria endemic regions of sub-Saharan Africa where supplies of the already available RTS,S vaccine cannot alone meet the high demand, said WHO in a statement on Thursday.

Some 100 million doses of the new vaccine are reportedly ready for rollout by SII, a major supplier of vaccines in Africa.

“Today marks a huge stride in global health as we welcome the prequalification of R21/Matrix-M, the second malaria vaccine recommended for children in malaria endemic areas,” said Dr Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals. “This achievement underscores our relentless commitment to wiping out malaria which remains a formidable foe causing child suffering and death.”

Nearly half a million children in WHO’s African Region die from malaria each year – making it one of the continent’s biggest early childhood killers, despite declining death rates over the past two decades.  Globally, in 2022, there were an estimated 249 million malaria cases and 608,000 malaria deaths across 85 countries.

R21 malaria vaccine administration in clinical trials sponsored by Oxford University, which concluded with regulatory approval of the world’s second malaria vaccine.

Prequalification ensures safe manufacture of the vaccine

In October, WHO recommended use of the R21/Matrix-M vaccine,  developed by Oxford University and manufactured by Serum Institute of India, for the prevention of malaria in children following a review by the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Group.

However, WHO “prequalification” remains a prerequisite for bulk vaccine procurement by UN agencies as well as for many other donor-supported programmes in countries. Effectively, the pre-qualification label confirms that the manufacture of the vaccine, in this case by SII, meets international standards.

“Achieving WHO vaccine prequalification ensures that vaccines used in global immunization programmes are safe and effective within their conditions of use in the targeted health systems,” said Dr Rogério Gaspar, Director of the Department of Regulation and Prequalification.

The first malaria vaccine to be approved by WHO, RTS,S/AS01 vaccine, obtained prequalification status in July 2022.  While the second vaccine R21/Matrix-M seemed to show even better results in some of clinical trials conducted prior to regulatory approval, WHO has said both are equally effective, noting that the two vaccines have not actually been tested head-to-head.

“Both vaccines are shown to be safe and effective in clinical trials, for preventing malaria in children,” said WHO in its statement. “When implemented broadly, along with other recommended malaria control interventions, they are expected to have a high public health impact.”

Image Credits: WHO/Fanjan Combrink, University of Oxford/Tom Wilkinson.

Nurses| Cameroon
Student nurses prepare for the morning rounds at the Ndop District Hospital in Cameroon.

The worldwide shortage of nurses should be considered a “global health emergency” – yet governments are failing to invest in measures to retain these essential workers, according to Howard Catton, CEO of the International Council of Nurses (ICN).

“The US has lost 100,000 nurses since 2020 and is predicted to lose up to 600,000 by 2027. The number of nurses leaving the UK register is also up since 2020. And in Switzerland, the dropout rates of new nursing students in their first year and second year is between 18 and 36%,”  Catton told a briefing hosted by ACANU, the Geneva UN press association.

Despite increasing evidence of nurses leaving or planning to leave the workforce, “governments are not in sufficiently prioritising investment in the nursing workforce”, he added.

“Improved working conditions and support and investment for the current nursing workforce need to be a priority to hold those nurses that we have.”

Governments are more focused on recruitment than retention of nurses, added Catton – and international recruitment by certain wealthy countries is decimating the healthcare in less affluent countries.

Recruitment from ‘red list’ countries

Howard Catton, CEO of the International Council of Nurses (ICN)

“A small number of high-income countries are driving 70% to 80% of recruitment activity,  overwhelmingly from countries in a weaker position than themselves. 

“Just in recent days, the UK announced that it had reached a target to recruit 50,000 more nurses earlier than planned. But it turns out 93% of those 50,000 were internationally recruited nurses, and we know that 6,000 of them came from the most vulnerable countries – the red list countries, that the World Health Organization (WHO) advises not to recruit from.”

Fiji has lost 25% of its nurses in the last year to Australia and New Zealand, he added.

In 2023, the WHO identified 55 countries – 37 from Africa – with “low workforce density” that might require “safeguards against active international recruitment” of their health workforce.

“The focus of government action, where we do see it, appears more on recruitment than retention,” said Catton.

“Recruitment, of course, is important in the medium to long term. But there’s a time lag. And the most simple, incontrovertible truth is that improved working conditions and support and investment for the current nursing workforce need to be priorities to hold in those nurses that we have.”

The rise in nurses’ strikes and disputes is an indication of the impact of the post-pandemic cost of living crisis, with a fall in real pay being reported even in Italy, Portugal, Finland and the UK. 

However, said Catton, “The approaches governments are adopting are unsustainable, and we’re concerned that there is a risk of more disputes and unrest over the year to come without the prioritisation of investment”. 

Pamela Cipriano, president of the International Council of Nurses (ICN)

ICN president Pamela Cipriano pointed out that slogans such as “health for all”, ‘leave no one behind’ and universal health coverage all depend on nurses – yet there is insufficient investment in nurses and nursing. 

“We need to move nurses from being invincible to being considered invaluable,” she added, cautioning those wanting to bring in workers who are less experienced and less expensive, “We urge great caution because someone with lesser education and training cannot replace the expertise of a nurse.”

Support for nurses in Palestine 

While the ICN did not involve itself in geopolitics, “there should be complete protection of health care facilities, health care workers and civilians in any area of conflict and war”, said Cipriano.

“We know that that’s been violated [in the occupied territories of Palestine], so we have spoken out against that. We, along with many other groups are calling for peace but also very specifically, protection of health care facilities and adherence to international law.”

The ICN had provided some financial support to Palestinian nurses, who are currently not being paid, “but not anywhere near the magnitude that they would need and hoping that we can help them to connect with other groups that can provide some financial support”, she added. 

Aside from financial support, Cipriano noted that nurses in the occupied territories needed education to deal with “new patient groups” as “the wounds of war are different from normal care”.

“Right now, we know they’re working in conditions where electricity, water supplies, medications, are at risk, so they are working in serious disaster conditions,” said Cipriano.

“Many times our other associations step up to help one another, either financially or it may be that regionally, there can be physical support.”

Tribute to Israeli nurse held hostage

Cipriano also paid tribute to Nili Margalit, an Israeli nurse kidnapped by Hamas on 7 October and held hostage for 55 days.

“She’s a 41-year-old nurse and… [she was able to] get medications to the people who were in the tunnel where she was being kept, to give them hope, to be the communicator, to be the organiser.,” said Cipriano 

“That is what nurses do. They rise in the face of crisis, as well as [during] the daily and life events that that people are facing. 

“In conflict and crisis, we can rely on nurses even though we know it also takes a tremendous mental toll on their well-being.”

Image Credits: © Dominic Chavez/The Global Financing Facility.

Al Shifa Hospital in northern Gaaza at time of WHO delivery of medical supplies on 16 December, 2023

From earthquakes in Afghanistan to floods in Libya and the conflicts in Gaza and Sudan, WHO’s Eastern Mediterranean region, is beset with one of the world’s largest concentrations of people trapped in humanitarian crises and in desperate need of emergency health services, food aid, as well as peace,  said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, Tuesday. 

“Our region is home to 38% of the global population in need of humanitarian aid, which means over 140 million persons,” said Al-Mandhari, speaking from the WHO Regional Office in Cairo at an end-year WHO briefing.  “This number represents the everyday tragedies experienced by the people of Syria, Afghanistan and Iraq after earthquakes. The lived horrors of the people of Libya after catastrophic flooding, drought in the Horn of Africa, the rapidly worsening conflict in Sudan, and of course, the humanitarian crisis that continues to unfold in Gaza with unprecedented brutality.”

The Palestinian death toll in Gaza from the conflict between Israel and Hamas is now approaching 20,000 people, with high levels of hunger, crippled health services and growing prospects of disease outbreak, Mandhari warned.  At the same time, the  brutal war raging in Sudan between the Sudanese Armed Forces and the paramilitary Rapid Support Forces (RSF), has led to the displacement of some 7 million people, leaving some 4.9 million people on the brink of famine, he said.

Dr Ahmed Al-Mandhari, WHO Director for the Eastern Mediterranean Region

Unlike Gaza, the Sudanese civil war has been happening pretty much “off the radar screen”, added Dr Richard Brennan, Regional Emergency Director, WHO Regional Office for the Eastern Mediterranean, at the briefing. 

“We’re not seeing much on the news media, in the international media,” observed Brennan.  However, there has been a marked escalation in hostilities over the past several days as RSF forces advance on the city of Wad Madani, south east of Khartoum, where hundreds of thousands of poeple from the capital had taken refuge and many are now forced to flee.

“Over 24 million people are in need of aid. It’s the largest displacement crisis in the world today,” said Brennan of the Sudan war. “There are high levels of fighting and violence, high levels of displacement, a major food and security crisis. People are going hungry.  There is a rapidly progressing cholera outbreak, as well as rapidly spreading outbreaks of malaria, dengue and measles.”

Dr Richard Brennan, Regional Emergency Director, WHO Regional Office for the Eastern Mediterranean

Meanwhile, the western Sudanese region of Darfur, there has also been a fresh escalation of war-related violence against civilians, including “terrible stories of sexual violence against women and atrocities against the husbands and partners,” said Brennan. But despite the crisis there are large areas of the encircled region to which WHO and other humanitarian relief groups have no access at all. “We can only reach Darfour from cross border operations via Chad,” he said.

Sudan war: pink indicates areas controlled by Sudanese Armed Forces and allies as of 10 December 2023; green indicates control by Rapid Support Forces; yellow indicates control by Sudan People’s Liberation Movement-North.

WHO immediate aims for Gaza relief in ‘shrinking humanitarian space’

On Sunday, 11 December the WHO Executive Board approved a draft resolution to the World Health Assembly calling for the “immediate, sustained and unimpeded passage” of humanitarian relief to Gaza, including healthworkers, vehicles and supplies.

The most immediate needs include restoring the functionality of at least four hospitals in northern Gaza, with the support of emergency medical teams; expanding bed capacity and operations in southern Gaza hospitals, now in the line of fire as well; and a “better organized” medivac for wounded and ill Palestinians to Egypt or elsewhere abroad, said Dr Richard Peeperkorn, representative to WHO’s Jerusalem-based office in the Occupied Palestinian Territories (OPT).

Dr Richard Peeperkorn, WHO Representative, occupied Palestinian territory

But such aims faced huge challenges in light of the “shrinking humanitarian space.. and military activities making it very difficult for the One UN, including WHO, to move supplies, staff and patients.”

Coordination for safe passage of patients, health workers and supplies is “incredibly cumbersome,” he added, noting that a WHO mission to two northern Gaza hospitals had to be cancelled on Tuesday, due problems in coordinating safe passage.

On a visit to Al Ahli Hospital, in Gaza’s north last week, Peeperkorn said that he was “shocked” both by the scenes of urban devastation around the hospital and the needs inside, which were “unlike anything I had seen in my life.”

He described wounded people being brought in for emergency treatment on horse and donkey carts with over 200 patients “everywhere”, including the chapel of the hospital, operated by the Anglican Church.

Yesterday, Peeperkorn said he had received reports that “the fence surrounding the hospital had been demolished and there were tanks stationed outside.” A dozen people on the hospital grounds were reportedly arrested and remain in detention, including five staff.  That follows on a pattern of previous Israeli detentions and arrests of health workers at Al Ahli and elsewhere, he said.

“They’ve asked who to support with medical supplies, water and fuel. So we are planning a mission there tomorrow. But we hope on the current circumstances that this is possible,” Peeperkorn concluded.

More calls for Gaza cease-fire but prospects remain dim

WHO Executive Board meeting on the health and humanitarian situation in Gaza, Sunday. 10 December saw a fragile consensus reached.

“Stop this war, with no delay,” said Al Mandhari of the Gaza conflict.

In Sudan, “we absolutely need a ceasefire but unfortunately the military offensive is continuing, and more and more people are going to get caught up in the crisis because of the onward march of the military offensive,” added Brennan.

Yet another UN Security Council vote on the Gaza situation was scheduled for later Tuesday. Under US pressure, a fresh UN Security Council call for a “an urgent and lasting cessation in hostilities” had reportedly been watered down to call for an “urgent suspension of hostilities”.

Real prospects for a cease-fire in the near term seemed dim as Israel’s military advanced deeper into Gaza, including areas of the south where over 1.9 million displaced Palestinians are now living, after fleeing the north. Hamas has meanwhile said it will not negotiate over the release of more hostages under Israeli fire, demonstrating its resolve by lobbing missiles at Tel Aviv again on Tuesday, after releasing a new video Monday of three elderly Israeli hostages pleading for the Israeli government to prioritize their release along with the other 112 people still in captivity.

Israel initially launched air strikes on Gaza, followed by a ground invasion, in response to the 7 October Hamas incursion into Israeli communities near the Gaza enclave, in which gunmen killed over 1000 men, women and children in their homes along with young people at an outdoor festival.  Another 240 Israelis and foreign workers were carried back to Gaza, including about 30 children.

Some 114 hostages, mostly women and children, were released in a series of exchanges with Palestinian prisoners held by Israel during a week-long humanitarian pause in late November, before hostilities resumed. Israel has now seized large parts of northern Gaza, flattening most of the urban landscape, and carrying the battle to the tiny enclaves southern strongholds where most of Gaza’s population is now living in schools, around hospitals and makeshift shelters.

Israel, supported by the United States, Canada and other allies, has maintained that Hamas forces sytematically built tunnels, stored weapons and even hid hostages in and around health infrastructure, and any permanent cease-fire that leaves the organization’s military prowess intact would pave the way for more bloody attacks like that of  7 October, which Hamas leaders have already pledged to repeat.

Palestinians, supported by a large majority of other UN member states, have charged that the Palestinian civilian toll, including deaths of more than 7,000 children, has been disproportionately high, and the targeting of health facilities remains in contravention of international law regardless of claims about Hamas military deployment.

Regarding attacks on healthcare facilities, Mandhari issued an appeal to all sides, saying: “WHO and UN is always saying that attacks on healthcare is a breach of international humanitarian law, ..and any attack on these institutions or mobile teams on the ground is considered that way.  And we always call those conflicting parties to respect that law.  And if there is any breach, WHO encourages the relevant units, departments or organizations …to take it seriously and start doing whatever investigations are needed and then act against those who breach that sort of law.” 

Image Credits: @WHO, Eliajah Pepe/Wikipedia .

Vials of Pfizer´s COVID-19 vaccine.

Days after government officials took a break from frenetic pandemic accord negotiations, news broke that European countries had destroyed at least 215 million unwanted COVID-19 vaccine doses valued at over €4 billion.

The 19 countries surveyed dumped 0.7 doses per resident – with Estonia and Germany being the most wasteful, according to Politico, which broke the story this week.

In 2021, the European Union (EU) bought the equivalent of three doses per resident in secret deals with drug companies – hoarding these when African countries did not have access to any vaccines, not even for health workers.

Ending this cycle of waste and want is at the heart of the current pandemic agreement negotiations hosted by the World Health Organization (WHO). The talks are due to conclude in May 2024 with an agreement to govern countries’ conduct during pandemics – but parties seem to have entrenched disagreement about how best to ensure equitable access to vaccines and other medical products in future pandemics.


The People’s Vaccine Alliance’s Piotr Kolczyński said that the EU appears not to have learnt from its COVID mistakes, based on the positions it has taken during the pandemic agreement negotiations.

“The EU pumped unprecedented public funding into COVID-19 vaccines with no strings attached to ensure universal access. Yet, instead of learning from its mistakes, public funding conditionalities have been deleted from the draft Pandemic Agreement, and the EU is now trying to remove the remaining transparency and equity measures too,” said Kolczyński, who is the EU Health Policy Advisor at Alliance and Oxfam.

Several countries and non-state actors involved in the pandemic agreement negotiations advocate for governments that have invested public money in the development of pandemic products to retain a stake in these – via measures such as shares or joint intellectual property (IP) – so that private companies do not call the shots during pandemics.

However, the EU and the US have been lukewarm about this proposal.

COVAX lessons: Mitigating vaccine nationalism

Vaccine deliveries by the global COVAX facility.

Meanwhile, the four global co-convenors of the COVID-19 vaccine access platform, COVAX, urged in a joint statement on Tuesday that “future global pandemic preparedness and response architecture” be informed by COVAX learnings.

Noting that COVAX would close at the end of December, the Coalition for Epidemic Preparedness Innovations (CEPI), vaccine alliance Gavi, UNICEF and the WHO, highlighted three key learnings.

The first is the need to design, invest in and implement “an end-to-end solution to equitable access ahead of time” that “centres on the needs of the most vulnerable”.

While “vaccine nationalism will persist in future pandemics”, they urge “mechanisms to mitigate it – including by diversifying vaccine manufacturing so all regions have access to supply”.

The third lesson is “the need to take financial risks to avoid potentially deadly delays to the development, procurement and delivery of medical countermeasures”. 

Money left over from COVAX will be redirected to implement some of these lessons, including investing $1 billion in the establishment of an African Vaccine Manufacturing Accelerator (AVMA) to support African vaccine manufacturing, a measure announced recently by the Gavi board.

“In addition, a First Response Fund will be established to ensure financing for a vaccine response is immediately available in the event of a future pandemic,” they note.

New Africa-Caribbean solidarity

Meanwhile, Tuesday also saw the launch of a new South-South partnership, the Health Development Partnership for Africa and the Caribbean (HeDPAC) to strengthen health cooperation between Africa and the Caribbean.

“Promoting technology transfer for pharmaceutical manufacturing, building regulatory capacity, and enhancing universal health coverage will be core HeDPAC strategies,” according to a statement released via the WHO.

“COVID-19 left an indelible scar on our global solidarity and the right of all people to good health”, said Prime Minister Mia Mottley of Barbados. “It is our shared responsibility to ensure that the inequity of the global response to COVID-19 is not repeated. This is the kind of action that will allow us to help people where they need it most.”

HeDPAC will also focus on strengthening the health workforce in the two regions, and sharing innovative solutions in primary health care, with a special emphasis on climate resilience, and maternal and child health.

Pandemic negotiations 2024 deadline

The seventh meeting of the Intergovernmental Negotiating Body (INB) negotiating the pandemic agreement ended late on 7 December with a rapid and vapid report back – likely indicating that the negotiations remain difficult.

While informal inter-sessional meetings are set to continue in early January, the INB meets for the eighth time from 19 February to 1 March 2024. 

A ninth meeting is also planned before the World Health Assembly at the end of May at which the pandemic agreement is due to be presented.

Image Credits: Photo by Mat Napo on Unsplash, @CEPI .

Some of those petitioning against Uganda’s Anti-Homosexuality Act in court on Monday, including Pepe Onziema (left) and Frank Mugisha (centre).

The court challenge to Uganda’s Anti-Homosexuality Act, one of the harshest anti-LGBTQ laws in the world, began in Kampala on Monday before five Constitutional Court judges.

The Act, which was passed by an overwhelming majority of Members of Parliament in May, includes penalties such as a life sentence for same-sex acts between consenting adults, 10 years in prison for “attempted homosexuality;” the death penalty for “aggravated homosexuality” and 20 years in prison for  “promotion of homosexuality”.

However, there is unlikely to be much more live court action after Deputy Chief Justice Richard Buteera, chair of the hearing, agreed to entertain written submissions rather than live hearings.

This followed a request by the lawyers representing the eight petitioners, including MP Fox Odoi-Oywelowo, and LGBTQ leaders Frank Mugisha and Pepe Onziema,  that they wished to proceed by way of written submissions.

Respondents, the Attorney General, supported by evangelical Pastor Martin Ssempa and Watoto Church elder Stephen Langa, served the petitioners with their written submissions at the hearing, and the court directed the respondents to reply by 5pm on 20 December.

Thereafter, the court will deliver its judgment “on notice”, either in court or electronically.

Commenting on the decision, Nicholas Opiyo, the attorney for the petitioners, said that the intention was “to avoid the theatrical intention of some of the people admitted into the process whose only objective appeared to be using the court as a platform to raise money and profile”. 

“In the end, a decorous process to preserve the integrity of the court and the hearing was chosen over and above oral presentation,” added Opiyo on X inan apparent reference to Ssempa’s attempts to use the court challenge to fundraise for his anti-LGBTQ crusade.

Researchers threaten to withdraw after directive 

Meanwhile, Uganda’s National Council for Science and Technology faced international condemnation for directing all researchers to report anyone who violated, or was suspected to be violating, the Act in their research programmes to the police.

In an open letter sent to Dr Martin Ongol, acting secretary of the council, some 260 researchers worldwide call on him to immediately withdraw a directive he issued on 27 October.

 

The directive informed researchers that “the duty of confidentiality in research may be waived for the purposes of reporting to the relevant authorities the commission of an offence” in terms of the Anti-Homosexuality Act.

The Act itself obliges citizens to report anyone who has committed or intends to commit any offence under the Act or face “a criminal penalty or a fine”.

“This Directive means we cannot uphold our moral commitment to the rights of our study participants to life, health, dignity, integrity, self-determination, privacy, and confidentiality,” notes the letter.

“We are asking you to immediately withdraw this Directive, if not, we will be forced to reassess our current research in Uganda and our future research plans.”

Uganda has already paid heavily for its homophobia, with the county’s new World Bank loans currently on hold along with new grants from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the country’s exclusion from the US African Growth and Opportunity Act (AGOA) that gives preferential trading terms to select African governments and US visa sanctions on key supporters of the Act, including all the MPs who voted for it.