self-care
Self-care proved essential during the height of the COVID-19 pandemic, when millions of people around the world took testing and their health into their own hands to ease the strain on overwhelmed healthcare systems.

BERLIN, Germany — Last week, the World Health Summit in Berlin brought together experts, civil society, politicians, and international organizations from around the world to brainstorm solutions to the many threats facing healthcare systems today. 

Climate change, the looming health workforce crisis, and the increasingly distant goal of universal health coverage were all on the agenda. Panels and plenaries debated solutions like artificial intelligence, innovative financing mechanisms for global health, and the use of pharmaceutical innovation and digital technologies to further equity.

Yet the oldest solution in the book, self-care, received little attention. A panel organized by the Global Self-Care Federation (GSCF) and the World Health Organization (WHO), in a small conference room on the outskirts of the summit, was the only event to make it a focus.

That needs to change. Amid a widening health workforce crisis and a lack of universal health coverage for half the world, a broad alliance of public and private stakeholders are urging governments to recognize and develop self-care as a critical component of health systems. Their call is backed by a new joint statement on self-care launched at a World Health Summit, and signed by the WHO and three other UN agencies.

Formal care is only the tip of the iceberg

The global and economic value of self-care in data.

“When I think about the whole health continuum, I see an iceberg,” said Jurate Svarcaite, Director-General of the Association of the European Self-Care Industry, speaking on the panel. “The formal health system is what you see above the water, and self-care is what’s under. This invisible part of the iceberg is very difficult to visualize until you have the figures – and the numbers are really staggering.”

The self-care that people provide themselves and their families is essential to keeping even the most advanced healthcare systems afloat. Without it, the EU would need an additional 120,000 GPs, at a cost of $34 billion per year. Self-care allows physicians to focus on acute care by saving them nearly 1.8 billion hours per year globally, according to GSCF, a non-profit based in Geneva.

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective. 

Advances in over-the-counter medicines mean pharmacists can now empower patients by providing advice and treatment for a wide range of minor illnesses, such as coughs, colds, and skin conditions. This can help to reduce the burden on GPs and hospitals.

“Even in countries that have well-equipped and well-resourced health systems, I’ve never heard of a health system saying they have too many resources or too many healthcare professionals,” said Goncalo Sousa Pinto, Lead for Practice and Developmental Transformation at the International Pharmaceutical Federation.

“It is impossible to have sustainable health systems unless you revamp and you really invest in and strengthen primary health care – and self-care is really a way of responding to that challenge,” said Pinto. “It’s about prevention, it’s about early diagnosis, and it’s about reducing pressure on health systems so that patients that require more time in their health system can benefit from high-quality care.”

Self-care savings 

The COVID-19 pandemic demonstrated the essentiality of self-care in times of crisis. Healthcare systems would have collapsed, not just struggled, if millions of people around the world had not taken matters into their own hands.

“COVID really dropped the pin – all of us had to self-care,” said Svarcaite. “We were asked to stay home if we were sick, even if we caught COVID we just had to go to the pharmacy to get paracetamol for whatever symptoms we were feeling.” 

“We had to try not to go into the formal health system because it was caring for really, really sick people that needed the full attention of healthcare professionals,” Svarcaite added.

Self-care, enabled by enhanced health literacy, over-the-counter medicines, devices, and preventive care, can enable people to manage their health conditions and improve their productivity by up to 40.8 billion days globally, she said, referring to a 2022 report on self-care’s social and economic value. It is also often the only option for the nearly 4 billion people who do not have access to essential health services.

“There was not one country which had its health system saying ‘Hooray! We are ready, we can do the COVID, bring us more,’” said Svarcaite. “All health systems struggled, and it just shows that self-care is part of health system resilience.”

Self-care is not new, but it presents one of the highest impact ceilings and cost-benefit ratios to deal with some of the most intractable health problems of the future, such as climate change, conflict, displacement, and the health workforce crisis.

“We need to find new ways to deliver health and healthcare services,” Bente Mikkelsen, director of Noncommunicable Diseases at WHO, earlier told another World Health Summit panel focusing on the healthcare workforce. “For me, that can be the recommendation of self-care information.”

Self-care: A lifeline for sexual and reproductive health

Inequalities continue to be a fundamental challenge to global efforts to achieve universal health coverage, particularly for sexual and reproductive health and rights, according to the UN joint statement.

“Nowhere is the need for self-care more urgent than in sexual and reproductive health, where inequalities run deep,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual and Reproductive Health and Research. 

Nearly 800 women die every day from preventable causes related to pregnancy and childbirth. 164 million women of reproductive age worldwide have an unmet need for contraception, one in three face sexual violence in their lifetimes, and over 1 million newly sexually transmitted infections are acquired every day. 

Self-care interventions, such as self-testing for pregnancy diagnosis, self-sampling for HPV and other infections, and self-management of medical abortion, can help to reduce these inequalities and empower women to make informed and independent choices.

“In so many places around the world, pregnancy self-tests are not available,” said Dr Manjuula Narasimhan, who leads WHO’s Sexual Health and Well-Being Unit. “If it’s not available at the pharmacy, it’s not available to that adolescent young girl asking ‘Am I pregnant? How do I find out?’”

WHO’s Sexual Health and Well-Being Unit Dr Manjuula Narasimhan speaks at the World Health Summit.

Pregnancy self-tests are a common and accessible means of contraception in high-income countries, but they are often unavailable or inaccessible to women in low-income countries. This can pose a significant barrier to women’s health and well-being, as early knowledge of pregnancy is essential for accessing timely and appropriate care.

In many low-income countries, pregnancy self-tests are not available in pharmacies or other retail outlets. They may only be available through health facilities, which can be difficult or impossible to reach for women who live in remote areas or who face stigma or discrimination.

“If the only way she can find out is to go to a clinic and do a blood test — likely in the local clinic where everybody knows her, and are wondering why she’s coming in — then that is a problem of equity,” said Narasimhan. “It is a problem of people having that ability, that agency, to be able to make informed decisions about their health.”

Health literacy: an essential pillar of self-care

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective.

Self-care can reduce the burden on healthcare providers. But self-care can only be effective when health literacy is well-integrated into health system strategies.

“Self-care is intrinsically patient-centric,” said Pinto. “But for these interventions by patients to be effective and to be the best options for patients, the pillar of health literacy and self-care literacy needs to be there. 

But health literacy is more than handing out pamphlets. It requires tailored awareness campaigns targeting the needs of local populations.

“Literacy is not just giving up a pamphlet and a brochure that they can read and many populations actually can’t read either,” said Dr Téa Collins, Platform Lead for Global NCDs at the WHO. “We need to be aware of the diversity of countries and the diversity of healthcare systems, knowing they are not all equipped to do things a certain way.

“There are also very different value systems because in different cultures there are different ways of managing health and disease,” Collins added. “We need to really consider and be culturally sensitive.”

A paradigm shift

Self-care panel underway at the World Health Summit in Berlin.

A shift towards self-care would require a paradigm shift in modern health systems, which are still largely based on top-down approaches to patient care.

“When we are talking about the medical model of care, particularly for those of us trained in this system, we are still gravitating towards this top-down approach,” said Collins.

A shift towards self-care would require a more collaborative approach to healthcare, with patients and healthcare providers working together to develop and implement care plans that are tailored to individual needs. It would also require a greater investment in health literacy and self-care literacy programs.

Self-care is not a magic bullet, but it is a critical part of the solution to the health workforce crisis and the broader challenges facing healthcare systems today.

A new joint UN statement recognizes the potential of self-care

The joint statement was issued at the World Health Summit by the World Health Organization and three other UN agencies.

As a next step, GSCF and its partners are calling on the World Health Assembly to adopt a resolution on self-care. The adoption of such a resolution would be a landmark moment for the advancement of self-care as a pillar of health systems.

“Self-care is an indispensable solution for realising Universal Health Coverage by 2030 and should be integrated into future health and economic policy, with a focus on affordability and access,” said Judy Stenmark, head of GSCF, which has been working in collaboration with WHO to advance self-care in policy agendas.

“A WHO Resolution on Self-Care would provide a comprehensive framework for governments, stakeholders, and the international community to strengthen self-care policies and interventions and would put us on a pathway to better health, well-being, and sustainable development,”  Stenmark noted.

The joint statement, released at the World Health Summit by WHO, the United Nations Development Programme (UNDP), the UN Population Fund (UNFPA) and the World Bank, outlines five priority areas for strategic investment and coordination, including:

  • Financing: We must implement innovative funding models that reduce costs, enhance efficiency, and build a more equitable system.
  • Expanding the health workforce: We need to expand the competencies of the health workforce to provide user-centred self-care options as part of high-quality primary care.
  • Fostering broad-based political will: We need to foster broad-based political will and accountability for integrating self-care across policies, programs, and sectors.
  • Strengthening regulatory systems: We need to strengthen regulatory systems to assure the safety and quality of self-care interventions.
  • Generating robust evidence: We need to generate robust evidence on the health economics and social impacts of self-care while respecting patient preferences.

“The statement represents a watershed moment,” said Allotey. “We really, really have a lot of work to do.”

Image Credits: Annie Spratt, CC.

The unequal distribution of vaccines between countries at the height of the pandemic manifested “as a global system privileging those former colonial powers to the detriment of formerly colonised states and descendants of enslaved groups,” according to the UN Committee on the Elimination of Racial Discrimination.

For centuries, colonialism has shaped global healthcare, leaving behind a legacy of disparities and injustices between the Global North and Global South that continues to exert a profound influence on the health and well-being of marginalised and indigenous populations across the globe.

Today, colonialism’s legacy is being challenged by a growing movement to decolonise the healthcare sector by shifting power to marginalised communities and empowering them to design and deliver their own care.

At a recent panel discussion hosted by the Global Health Centre of the Geneva Graduate Institute, in collaboration with Medicus Mundi, experts from across the health spectrum discussed practical steps to decolonise global health governance and give marginalised communities a greater voice and agency in their own healthcare systems.

“We are speaking about localisation, shifting powers and decolonising,” said Hafid Derbal, Co-Desk for Sexual and Reproductive Health and Rights (SRHR) and Co-Program Coordinator for Zimbabwe, South Africa and Mozambique, Terre des Hommes Schweiz. “Who is ultimately benefiting from our work and these changes? It must be the people we work with – the local organisations and civil society.”

One example of this approach is community-based healthcare initiatives, which tailor services to the specific needs and preferences of the local population. 

“Participative urbanism is a concept that we came up with to bring the voice of the marginalised as part of the mainstream public policy,” said Danny Gotto, founder and executive director of Innovations for Development (I4DEV), Uganda.

“We created a space for people in so-called slums to voice their concerns based on their context, based on their cultures, based on their interests, based on their aspirations,” Gotto said. “Then, we created a space for dialogue between policymakers and the common people to ensure that they decolonise urbanism because the context of urbanism, as borrowed from the West, is that the poor all live on the fringes.”

On a broader scale, collaborations are emerging to support countries with limited resources to manage specific health conditions. For example, the African Centers for Disease Control and Prevention (Africa CDC) is dedicated to building Africa’s capacity to confront healthcare challenges.

“Because many national health organizations lack the capacity and resources to represent what’s going on, the African Union’s creation of the Africa Center for Disease Control and Prevention has great potential,” said Ravi Ram of the Kampala Initiative and co-chair of the WHO Civil Society Commission.

Colonial legacies often resulted in the suppression of indigenous healing traditions and the imposition of Western medical paradigms. Ongoing efforts are underway to decolonize global health education by revising curricula to encompass diverse perspectives and local knowledge and experiences.

Dr Agnes Binagwaho.

“First, we educate students to amplify the voice of the marginalised and vulnerable people in the country, the region, the societies, the communities, and families,” Agnes Binagwaho, a former minister of health in Rwanda and the retired vice chancellor of the University of Global Health Equity, told the panel.

“We educate our students inside the communities the most in need in the country. Normally, medical schools are in cities and in the richest part of countries, not where the most needs are for health professionals. On top of that, we put our students in direct contact with local, national, and regional leaders,” Binagwaho said.

However, the idea that decolonisation is only about the Global North versus the Global South was challenged during the panel discussion. Power imbalances in global health extend beyond former colonial powers, reaching into emerging economies where this disconnect poses challenges for policymakers and healthcare organisations.

“India has also been following, in many ways, a colonial mentality toward its development programs,” said Kampala Initiative’s Ram. “We saw that in COVID, where protectionism overruled their public commitment toward sharing vaccines.”

“Brazil is doing the same work in Latin America, using its regional dominance, trade, and other economic factors to dominate smaller states, even within Brazil,” Ram added. “Much of the general and Afro-Brazilian populations have been excluded from the formal health system.”

WHO
Proposals to include intellectual property waivers for vaccines during the next pandemic in a potential Pandemic Treaty have run up against sharp resistance from the pharmaceutical industry and rich countries.

The inequities of the COVID-19 vaccine rollout exposed the deep inequities in global health, leading to calls for a decolonisation of the sector and negotiations on international legal instruments like the World Health Organization’s (WHO) Pandemic Treaty.

The WHO’s “zero-draft” treaty proposes that 20% of pandemic-related products, such as vaccines, diagnostics, protective equipment, and therapeutics, be allocated to the organisation, which can then ensure equal distribution.

But the increasing monopolisation of entire economic sectors and various forms of profiteering are threatening to derail the Pandemic Treaty. Vaccine inequity was not solely shaped by perceived colonial division, but also the increasing monopolisation of the healthcare sector by private companies, the panelists said. 

“We’ve seen that member states and international organisations won’t necessarily be representing a national interest in the sense of the public. They’ll be representing a corporate interest,” said Ram. “I want to call attention to what’s happening here in Kenya, where a lot of health service delivery is being increasingly encroached upon by Indian corporates, where the Indian private sector is probably one of the most privatised in the Global South.”

Binagwaho echoed this concern, adding: “Money is controlled by the people who don’t want to change because they benefit from the system they have created over decades, and they’re resisting a lot.

“They have to give up a little, but to change that, we must change the world’s economic structure.”

Image Credits: CC, US Mission Geneva.

Trucks carrying humanitarian aid wait to cross into Gaza from Egypt through Rafah border point – some 74 have now passed but WHO says its not nearly enough.

The World Health Organization has issued its most forceful statement to date calling for the immediate release of some 200 Israelis and foreigners, including health workers and children, abducted by Hamas and other armed groups from Israel on 7 October during a deadly rampage of 22 Israeli communities that left about 1300 other people dead.   

Meanwhile, WHO’s Eastern Mediterranean Regional Office (EMRO) issued a fresh appeal for the entry of fuel supplies as well as more medicines  to Gazan overburdened hospitals, struggling to cope with a rising toll of casualties from unprecedented Israeli air raids. Since Saturday, Israel has the allowed entry of  74 trucks of food, water and medical aid. But it has barred fuel deliveries to the besieged enclave in an effort to stem the blitz of missiles being fired on Israeli cities by Hamas, and deplete its fuel reserves while staging the initial phases of a promised ground incursion into Gaza.  US President Joe Biden, a staunch supporter of Israel in the conflict, has admitted that the Gaza aid deliveries aren’t getting in “fast enough.”

WHO hostage statement

Outside of UN Headquarters in Geneva, demonstrators call for the release of some 222 Israeli and foreign hostages held by Hamas. In the past week, families have also met with the heads of WHO, the ICRC and the UN High Commissioner for Human Rights.

The WHO appeal on the hostages came late Wednesday evening following a meeting between WHO Director General Dr Tedros Adhanom Ghebreyesus and members of an Israeli civil society group representing families of those abducted. 

WHO is “gravely concerned by the humanitarian and health situation facing approximately 200 people, including health workers and up to 30 children, abducted from Israel by Hamas and other armed groups on 7 October 2023,” the statement said. It called for “the immediate release of all the hostages, along with urgent access to each of them and delivery of medical care.” 

Said Tedros, “We met today with families of people abducted from southern Israel on 7 October and heard firsthand the tragedy, trauma and suffering they are facing. There is an urgent need for the captors of the hostages to provide signs of life, proof of provision of health care and the immediate release, on humanitarian and health grounds, of all those abducted.”

Elderly, children and people with chronic health conditions

Two of the estimated 30 Israeli children taken hostage by Hamas at demonsration outside of the UN Headquarters in Geneva Sunday, calling for their release. Some families met with the heads of WHO, ICRC and the Office of the UN High Commisioner for Human Righs (OHCHR)

“Many of the hostages, including children, women and the elderly, have pre-existing health conditions requiring urgent and sustained care and treatment. The mental health trauma that the abducted, and the families, are facing is acute and psychosocial support is of great importance,” Tedros said.

The captives were taken after several thousand Hamas gunmen broke through an Israeli security fence separating Palestinian Gaza from pre-1967 Israel in the early morning of 7 December. Fanning out to some 22 Israeli villages and small towns nearby, the gunmen forced their way into hundreds of homes, and set others on fire. Survivors reported seeing neighbors and family members shot or bludgeoned to death, while a few were led away on foot,  motorcycles or in pickup trucks. 

So far, only four of an estimated 224 hostages have been released – including two elderly women, aged 85 and 79 on Monday, whose husbands remain in captivity.  Among the hostages are people of some 25 nationalities, including many Israelis with dual citizenship, but also Nepalese agriculture students and Thai caregivers who were working in the Israeli communities near Gaza.  A handful of the Israeli captives are Beduin Muslims, who live and work in the area.  

Since being taken captive, hostage families have launched a diplomatic campaign in Europe, North America and at UN institutions.  Last week some hostage family members also met in Geneva with the president of the International Committee of the Red Cross and Volker Turk, UN High Commissioner for Human Rights, on a tour that has also taken some families to Brussels and around European capitals as well as to the UN Security Council meeting in New York.   

WHO Eastern Mediterranean Office issues fresh appeal for Gaza fuel supplies 

Displacement of Palestinian families from northern Gaza to one of the UNRWA schools in Gaza City to escape the ongoing Israeli airstrikes on Gaza since October 7, 2023.

Meanwhile, WHO’s EMRO office warned again that more Gazan hospitals are facing collapse, due to the lack of fuel and the collapse of the electricity grid.

“In addition to the hospitals that have had to close due to damage and attacks, six hospitals across the Gaza Strip have already shut down due to lack of fuel, said the WHO/EMRO statement. 

“Unless vital fuel and additional health supplies are urgently delivered into Gaza, thousands of vulnerable patients risk death or medical complications as critical services shut down due to lack of power. These include 1000 patients dependent on dialysis, 130 premature babies who need a range of care, and patients in intensive care or requiring surgery who depend on a stable and uninterrupted supply of electricity to stay alive.” 

Since last Saturday, some 74 trucks carrying food, water and medicines have been allowed by Israel to pass into Gaza through Egypt’s Rafah, with 12 trucks crossing in the latest relay, on Thursday. 

However, UN Refugee Works Agency (UNRWA) officials say that is only about one-tenth of the aid that used to cross into the besieged Gaza strip, before the war broke out – and bereft of fuel.

WHO statements coincide with intense diplomatic activity on hostages and  de-escalation 

Palestinian man walks across a pile of rubble in Gaza, whish has seen the heaviest bombing attacks ever by Israel.

The WHO meeting and statements coincided with a UN Security Council debate Tuesday and Wednesday on the Israel-Gaza conflict, which ended in a veto by Russia and China of a proposed US resolution calling for a humanitarian “pause” in hostilities but also condemned Hamas and affirmed Israel’s right to defend itself. A competing Russian resolution that also called for a pause and condemned Hamas, but omitted language about Israel’s right to self-defense, failed to get the required 9 Security Council votes. 

While there have also been reports that Hamas is negotiating with mediators in Qatar, Egypt and elsewhere for the release of more Israeli captives, the hostage mission is vastly complicated by repeated Israeli threats to enter Gaza and remove Hamas altogether from power.  

The Hamas attacks on wide swathes of southern and central Israel, as well as from the northern Lebanese border, have led to the displacement of some 200,000 Israelis. Some of the Gaza-area Israeli villages that were the scenes of massacre on 7 October, are now mere burnt out ruins. 

But that is nowhere near the level of destruction now being seen in densely populated Gaza – where average people lack access to the network of shelters that Israel has built for its civilian population against missile attack – not to mention its “Iron Dome” air defense system. Around one half of Gaza’s 2.3 million Palestinian inhabitants have reportedly been displaced.  

Gaza reports soaring casualties 

A Palestinian boy with his cat salvaged from an apartment bombed by Israel.

Gaza’s Hamas-run Health Ministry released Thursday a detailed report on 7,028 Palestinian casualties, including 2,913 minors as a result of the conflict. Although US President Biden has expressed scepticism as to whether the numbers indeed are that high, WHO and UN sources, say that the Hamas figures have usually been reliable, bearing up to post-war scrutiny.  The Hamas toll, however, does include some 471 people reported to have been killed in the explosion at Al Ahli Hospital, which French and US intelligence agree was an errant missile fired from Gaza. It also does not separate military from civilian deaths. 

Regardless, Palestinian casualties appear to now outpace the combined Gaza toll of all of its major conflicts with Israel since in 2008. And there is no doubt that Palestinian deaths far outpace the losses seen by Israel, which has lost 1,400 people, including 380 soldiers.   

And irregardless, Israel’s air raids on Gaza, some of the heaviest ever seen on an urban area anywhere in the world, have thrust average Palestinians deep into crisis – overcrowding hospitals, as well as schools and refugee centers. Israel also has called for the evacuation of most of northern Gaza, while it takes aim at the huge labyrinth of underground tunnels created by Hamas as refuge for its fighters and high-ranking officials. 

The fuel war 

Some Gaza facilities, like Nasser Hospital in Khan Yunis, now have solar power capacity – but PV cannot fill the energy gap left by fuel shortages.

Already two weeks ago, Gazan health officials warned that hospital fuel supplies would run out in days. Fuel is also  critical for powering Gaza’s desalinization plant to produce clean water, UN and relief workers stress, in light of the heavy salt-water encroachment and pollution of Gaza’s wells and underground aquifers. And it is essential to bakeries, producing bread, a critical staple food. 

As of this week, fuel reserves hadn’t yet entirely been exhausted. On Monday, WHO reported its delivery of  34,000 liters of fuel to ambulance services and four major hospitals in southern Gaza.  But “this is only enough to keep ambulances and critical hospital functions running for a little over 24 hours,” WHO warned. 

Meanwhile, Hamas has continued to strike out against southern and central Israel, hitting homes in the city of Rishon Le Zion Wednesday night, and at Tel Aviv on Thursday, even if the pace of attacks was slackening noticeably from as hundreds of rockets a day, fired at the beginning of the incursion. to around 100 a day.  Precisely because of that, Israel remains adamant about allowing fuel convoys  into Gaza – which they say could be filched by Hamas.  

In the past few years, more Gazan hospitals have also been fitted with large PV rooftop solar installations, as part of a major initiative by UNDP, as well as WHO and bilateral donors – to cope with chronic interruptions in electricity grid supply that were a problem even before the war. But PV solar capacity is still under development, and clearly cannot meet the needs of flooded hospitals now. Moreover, one of the hospitals with one of the biggest and newest PV installations, the Palestinian Red Crescent’s Al Quds Hospital, is located in the northern Gaza strip, which Israel has called to evacuate. 

–Updated Friday 27.10.2023 with further details of the death toll in Gaza, as reported by the Hamas-controlled government.

Image Credits: E. Fletcher , © UN Photo/Eskinder Debebe, E. Fletcher/HPW, WHO/Eastern Mediterranean Region , Care International , UNRWA, WHO, 2019.

A new report by the United Nations University warns that climate change is a major factor in pushing the world towards multiple tipping points, which will cause rapid and fundamental change to the planet.

Human activity is pushing the world towards multiple tipping points that will cause rapid and fundamental change to the planet, according to a new report by the United Nations University Institute for Environment and Human Security (UNU-EHS).

The Interconnected Disaster Risks report, released on Wednesday, identifies six key tipping points: accelerating extinctions, groundwater depletion, mountain glacier melting, space debris, unbearable heat, and an uninsurable future.

These tipping points are defined in the report as the moment at which a given system is no longer able to buffer risks and provide its expected functions. 

Once a tipping point is reached, it is irreversible and can lead to cascading failures of other systems. For example, the loss of mountain glaciers could lead to water shortages and mass migration, while unbearable heat could make some areas uninhabitable.

The report also highlights the interconnectedness of the tipping points, warning that they could trigger each other in a vicious cycle. For example, the loss of biodiversity could make ecosystems more vulnerable to climate change, which could lead to more extreme weather events and further biodiversity loss.

Running out of time

The report’s authors say that humanity is running out of time to avert disaster. They call for urgent action to reduce greenhouse gas emissions and protect ecosystems.

“These tipping points have either passed or are about to happen,” said Dr Jack O’Connor, lead author of the report and a senior export at UNU-EHS. 

“Depending on where you are in the world, you might have a little bit more time,” said O’Connor. “But you should be looking at what is happening in other places of the world because we are all interconnected, and the impacts of tipping points passing in other places will eventually affect you.” 

The report comes a month before representatives from all countries will meet at the annual UN Climate Conference, COP28, in Dubai.

Chain reactions are already underway 

Extinctions are already happening at an alarming rate. Animals are running out of places to feed and reproduce as humans take over more and more land, while climate change is making it harder for threatened species to survive. This loss of biodiversity is increasing the risk of a chain reaction of extinctions, which could have devastating consequences for ecosystems and human societies alike.

“Recent research has shown that the way that ecological networks have formed means that as we lose biodiversity, we increase the risk of this chain reaction of extinctions in an ecosystem,” said O’Connor. “Extinctions could accelerate at a much faster rate in the future.”

Depleting groundwater is another major tipping point that is already having real-world impacts, threatening food security in many parts of the world. Groundwater is essential for agriculture, providing a reliable source of water during droughts and other periods of water scarcity. 

Yet, in many parts of the world, groundwater is being extracted faster than it can be replenished. This is due to a combination of factors, including population growth, climate change, and unsustainable agricultural practices. 

Farmers who are already facing the vagaries of fluctuating rainfall can no longer rely on groundwater to make up the shortfall. Some countries, such as Saudi Arabia, have already surpassed the groundwater risk tipping point, while others, like India, are not far behind.

Impacts of today in the future

Rising space debris is becoming a major issue as more and more satellites are launched into low Earth orbit (LEO), the region of space closest to Earth that is already crowded with satellites. By 2030, as many as 100,000 satellites could be in orbit, posing a significant risk to other spacecraft and missions. 

“Communities and individuals can influence the other tipping points on the list … [but] I think this is the one where individuals probably have the least agency,” said Dr Zita Sebesvari, another lead author of the report and deputy director of UNU-EHS.

New research from the University of British Columbia’s Outer Space Institute echoes Sebesvari’s concerns, estimating that as many as one million satellites may be headed into orbit.

“By treating orbital space as an unlimited resource, humanity is creating serious safety and long-term sustainability challenges to the use of low Earth orbit (LEO), including science conducted from space and the ground,” the study said.

“If even a portion of these million satellites are actually launched, national and international rules will be needed to address the associated sustainability challenges, like collision risks, light pollution, and reentry risks,” Andrew Falle, lead author of the study, told Space.com.

Transformative change needed

The report provides two categories of solutions for each of the problems: avoid solutions and adapt solutions. Avoid solutions target the root drivers of the tipping points, while adapt solutions help prepare for or better address the negative impacts.

In the case of unbearable heat, the report suggests halting greenhouse gas emissions and driving society towards low-carbon ways of living as an avoid solution. An adapt solution would be to help install more air conditioners in places that need them the most.

The report emphasizes that current solutions are only working to delay the onset of the tipping points, not to avoid them altogether. While some work is being done on transformative solutions, these need to be scaled up significantly, the authors say.

“Real transformative change involves everyone,” Sebesvari said. “The report serves as a timely reminder before the UN Climate Conference that we must all be part of the solution.”

Two girls sit together after receiving their HPV vaccinations at their primary school in Masaka, Rwanda. Young girls who receive HPV vaccines can hope for a future free of cervical cancer. / Credit: UNICEF

Nigeria, Africa’s most populous country has introduced the human papillomavirus (HPV) vaccine into its routine immunization system, aiming to reach 7.7 million girls – in the continent’s largest-ever vaccination drive against the virus that causes nearly all cases of cervical cancer. 

Girls aged 9–14 years will receive a single dose of the vaccine, which is highly effective in preventing infection with HPV types 16 and 18 that cause at least 70% of cervical cancers,  WHO and Nigerian health ministry officials announced on Tuesday. 

Africa is one of the regions with the largest burden of cervical cancer deaths, due to a dearth of prevention, screening and treatment services.

In 2020 – the latest year for which data is available – Nigeria recorded 12,000 new cervical cancer cases and 8,000 deaths, making it the third most common cancer and the second most frequent cause of cancer deaths among women aged between 15 and 44 years.

“The loss of about 8,000 Nigerian women yearly from a disease that is preventable is completely unacceptable,” said Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare. 

“Cervical cancer is mostly caused by HPV, and parents can avoid physical and financial pain by protecting their children with a single dose of the vaccine. 

In November 2020, the WHO launched the “90/70/90” global initiative to eliminate cervical cancer as a public health problem. The strategy aims to vaccinate at least 90% of girls against HPV by the age of 15 years; screen 70% of women by age 35; and treat at least 90% of identified precancerous lesions and invasive cancers. 

Still, nearly half of LMICs have been unable to introduce HPV vaccinations, as many countries cannot still afford the vaccine at the $4,50 per dose procurement price negotiated by global health agencies, according to a 2023 article in BMC Public Health. 

Rwanda was the first sub-Saharan African country to introduce HPV vaccination in 2011. Uptake since has been slow with only a few other African countries integrating the vaccine into their routine basket of services, peaking in 2019 with six new countries: The Gambia, Liberia, Côte d’Ivoire, Kenya, Malawi and Zambia.  

UNICEF has recently launched a major initiative to bolster HPV immunization. In 2023, the agency is supplying some 36 million vaccine doses to 52 low- and middle-income countries worldwide. Some two dozen African countries have received some form of support for HPV vaccinations, whether or not they are yet integrated into the routine basket of immunizations. 

Image Credits: UNICEF.

“The transition to clean energy is happening worldwide and it’s unstoppable,” said IEA Executive Director Fatih Birol.

The International Energy Agency (IEA) has projected that global demand for oil, coal, and gas will peak by 2030, but that demand for fossil fuels is set to remain “far too high” to keep the Paris Agreement Target of 1.5C within reach.

The IEA now says that the transition to clean energy is happening worldwide and is “unstoppable”, according to its annual World Energy Outlook report, released on Tuesday. It credits the record growth of key clean energy technologies, such as solar PV and electric cars, for this shift.

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

The IEA predicts a surge in renewable technologies will underpin this green transformation of the global economy. By 2030, renewable energies such as solar, wind, and hydropower could provide nearly 50% of the global electricity mix, up from around 30% today. The number of electric cars on roads worldwide is projected to increase 10-fold.

“Peak” does not mean “decline”

The IEA projects that oil and gas demand will remain constant until at least 2050, as consumption increases in developing economies and decreases in advanced economies

For the first time in over 150 years, the global economy is poised to reach peak demand for fossil fuels – but charts in the IEA report show that “peak” does not mean “decline”.

While demand for coal – the dirtiest fossil fuel of which 55% is already sold at below market rates globally – will drop off sharply after 2030, demand for natural gas and oil will remain around 2030 “peak” levels until at least 2050. The IEA projects oil and gas demand will be buoyed by increases in consumption in developing economies which will offset expected decreases in advanced economies. 

The IEA also warns that governments are not doing enough to support the transition to clean energy. It recognized investments in fossil fuels will remain “essential” to keep the global energy mix balanced, but said that investments in fossil fuels are currently too high. Global fossil fuel subsidies surged to a record $7 trillion in 2022. 

“As things stand, demand for fossil fuels is set to remain far too high to keep within reach the Paris Agreement goal of limiting the rise in average global temperatures to 1.5C,” the report said. “This risks not only worsening climate impacts after a year of record-breaking heat, but also undermining the security of the energy system, which was built for a cooler world with less extreme weather events.”

Projections at the mercy of political shifts on green energy

Three times as much investment will go into new offshore wind projects than into new coal- and gas-fired power plants by 2030, the IEA projects.

The IEA’s assessment is based on current policies already implemented by governments and could change – for better or for worse – depending on whether governments backtrack or double down on major climate pledges. 

Former US President Donald Trump has already signalled he will try to repeal the Inflation Reduction Act, the largest package of green investment in US history, if re-elected in 2024. UK Prime Minister Rishi Sunak has also made a habit of backtracking on his country’s net-zero pledges, pushing ahead with plans to “max out” the UK’s fossil fuel reserves.

China, the world’s largest consumer of fossil fuels, is also a key factor. The country accounts for half the world’s coal use and has driven two-thirds of the growth in global oil demand over the past decade. China’s commitment to harnessing its green energy dominance to reshape its dependence on fossil fuels is essential to the IEA’s projections.

The fossil fuel industry has different ideas

Oil cartel OPEC supplies over half of the world’s oil and controls over 80$ of proven oil reserves.

The IEA assessment is in stark contrast to the views of the fossil fuel industry, which has long insisted that oil and gas will continue to play a major role in the global energy mix. The Organization of the Petroleum Exporting Countries (OPEC), the global oil cartel that supplies 51% of the world’s oil and controls 81% of proven oil reserves, said in its annual report earlier this month that it expects oil demand to increase by 17% by 2045.

The OPEC report called for expectations of what green energy can deliver to be more “pragmatic and realistic”, reflecting language used by the United Arab Emirates presidency ahead of the upcoming Un Climate Conference in Dubai, which will kick off in late November.

OPEC Secretary General and Kuwaiti oil executive Haitham Al Ghais wrote in the foreword of the report: “Calls to stop investments in new oil projects are misguided and could lead to energy and economic chaos.”

The bullish projections of OPEC are shared by American fossil fuel giants ExxonMobil and Chevron, who both announced plans to buy smaller shale producers in the United States a combined total of over $100 billion.

The International Energy Agency (IEA) has a mixed track record in forecasting fossil fuel demand. In 2016, the agency incorrectly predicted that China’s coal demand had peaked, while it had previously underestimated the rapid growth of renewable energy sources such as solar power.

A woman in Sierra Leone gets her blood pressure checked in 2022 as part of a new collaboration between Medtronic LABS, the Christian Health Association, and Sanofi Global Health.

Better access to NCD medicines and treatments isn’t enough to ensure effective prevention and treatment of the conditions, responsible for 74% of premature deaths in the world. More attention needs to be focused on  training, retention and effective use of health care workers, said a panel of experts at the World Health Summit.

BERLIN – Following the recent UN declarations restating ambitious health goals for universal health coverage, ending TB and preventing pandemics, global health leaders are re-examining the tool box of strategies that can help push this ambitious triple agenda forward.  

Ensuring a global health workforce fit for purpose is one important thread running through all of these challenges – and far more focus needs to be placed on this in order to ensure attainment of critical health goals, particularly UHC.  

“The health workforce is the ‘lifeblood’ of a health system,” noted Katie Dain, head of the NCD Alliance. “We can be talking about access to medicines, digital technologies, but you need the health workforce in order to be delivering.” 

She was speaking last week at a World Health Summit event on Harnessing innovation to empower the health workforce for NCDs

Katie Dain, CEO of the NCD Alliance

“Some 4.5 billion people are not fully covered in terms of basic, essential health services.  And these services must now include diagnosis and treatment of chronic conditions – rather than infectious diseases alone,” Dain added.  

And the global workforce will need to double by the year 2030 in order to be able to meet the needs of a still-growing, but also aging global population – particularly for NCD care.  

 “Among the challenges picked up through UN General Assembly declarations were the sheer numbers in terms of the shortage of health workers,” Dain said, noting that “we’re going to need  80 million by 2030. And while this is a global challenge, it is particularly acute in the poorest nations.”

The problem is not just sheer numbers but more subtle workforce challenges, related to recruitment, training and retention. 

“We have to ensure that we are incentivizing them to stay within the, and we also have to be aware of the gender dimension – essentially 70% of the health workforce are women. So this is a gender equality agenda as much as it is a health agenda,” Dain said. 

Training and equipping health workers for new NCD challenges 

Bente Mikkelsen, director of the Department of Noncommunicable Disease, WHO

Along with the broad challenge of insufficient numbers, health ministries and global health leaders have to ensure that workers are better trained to deal with NCDs – particularly in low–income countries, where chronic disease prevention, treatment and care were not typically part of the basket of primary health care services – which was traditionally geared to maternal and child care, immunizations, and infectious disease prevention and treatment. 

“Seven out of ten deaths from NCDs is tremendous,” said Bente Mikkelsen, head of WHO’s Department of Non Communicable Diseases, who spoke at the panel along with Dr Osahon Enabulele, president of the World Medical Association (WMA) and Paula Head, lead of Roche’s  Policy, Value and Access team.   

Mikkelson noted that the COVID pandemic provided a sort of wake up call to countries worldwide about the importance of NCD care. “When we looked into the excess mortality during COVID, we have very strong reasons to believe that a major part of that was also because of NCDs. And unfortunately, these numbers are growing…. So there is an urgency and I think we have a golden opportunity to make a crisis into huge awareness building.”

Added Dain: “All countries, but particularly low and middle income countries, are seeing the biggest NCD burden, in terms of cardiovascular disease, cancer, diabetes, chronic respiratory, mental health, you name it. And when you ask the question, are our health workforce globally equipped, ready oriented towards dealing with chronic conditions? The very clear answer is no. 

“We all know in NCDs that we’ve been playing catch up in a way connected to some of the other big global health priorities like HIV AIDS, TB, malaria, women and children’s health. NCDs over the last decade have really gained a lot of traction, but it’s still playing catch up.” 

Globally, only 2% of development assistance for health is directed to NCDs, and “that’s still really pitiful,” she noted. 

“And we know that the health workforce is in a way, a mirror of the broader health system. And essentially health systems in many low income countries are still oriented to acute care. They’re not really oriented towards a chronic care model, which also includes health promotion and prevention, and early diagnosis – which is so important in NCDs and also really doable.”

Using technology to empower health workers 

Checking for high blood pressure is a basic procedure that can be undertaken by most health workers even in settings with limited resources.

Mikkelsen laid out a number of ways in which simple, but more effective uses of health technologies could improve the effectiveness and efficiencies of the health workforce. 

“It’s not only about new devices, new technologies but it’s really about co-creation and how we work together.  I  think many of the real solutions, will be in the co-creation of new service delivery models rather than gadgets and new examples. 

“We think it’s about the numbers of doctors, the numbers of nurses, and then we forget we have pharmacists, we have a lot of other workers that can help the health system to deliver.  So that’s also an innovation that needs to be addressed, and this leads to task shifting and how do we really integrate?”

She cited as examples, the training of HIV healthcare workers to screen for cervical and breast cancers for example. 

“For the first time, we have 21 approved proposals to the Global Fund to address HIV and the spike of cancers together.  What this means is that those who are in this space, mostly HIV -trained healthcare personnel, will get the training to be able to address the needs of, say, cervical cancer. So it’s not only about more health care workers, but it’s also about the integration of needs that can address that.”

Similarly, health workers trained in administering routine childhood vaccinations “should of course, be able to do the vaccination for HPV.  And those who offer diagnostics, should also take the time to measure the blood pressure, and the blood pressure causes. 

COVID triggered new innovation – let’s make that the norm

Health worker meets with NCD patient Jane at the NCD clinic in Tulagi, Solomon Islands.

During COVID, health care workers and systems found new ways to innovate, so as to treat COVID patients while delivering more routine care, she pointed out. “Now, we need not to go back to normal, but to create a new normal.  Use the innovation that happened in the crisis in more normal times, to find new ways to deliver health and health care services.

More self-care education, including use of rapid at-home diagnostics is another example of innovation that blossomed during COVID – and now needs to be mainstreamed, Mikkelsen noted. 

“We’ve set a goal of having 70 of women screen with formal testing and women identified to get treatment. So what do we do? 

“I think one recommendation that was issued earlier this year that can help is the recommendation of self care interventions. Self testing, something you can do at home. 

It requires, of course, a pack of innovative digital solutions. And this can be developed together with the women that are at risk for cervical cancer, And that is also coming together with the other thing we do, which is to try to launch the AI for diagnostic assessments in the same area – as well as target product profiles to explain what are the products that we are looking for.” 

Finally, she stressed that training health workers to give more attention to preventing NCDs can help to reduce the burden of chronic disease. 

“Because that is really the untapped opportunity. We still are not on par when it comes to tobacco use and alcohol. And we are still going in the wrong direction when it comes to the obesity and physical activity,” she said, noting the average amount of medical school training on NCDs prevention currently amounts to about 3 hours in six years of training.  

Attracting and retaining health workers 

Osahon Enabulele, president of the World Medical Association (WMA)

COVID also saw significant attrition of health workers, both due to deaths from the disease as dropouts due to burnout, mental health issues and even experiences of violence, noted Dr Osahon Enabulele, new president of the World Medical Association.

“So the question is how do we create enabling working conditions? How do we create conditions that will make workers stay in their various practice centers?”

Health worker retention is a particularly big problem in Africa, which has 25% of the global disease burden, but just 3% of the health workforce, pointed out Enabulele, a Nigerian medical doctor by training. 

“We have a lot of pulling away of health care workers from Africa and Asia to Europe, America and other places that do not have enough health care workers. So it looks that the production of health care workers in Africa and Asia is for export to places like Europe, and that has implications for equity, for universal health coverage”. 

“SO we are looking at how we can, you know, better, you know, address these realities, but also how can we get governments to be more accountable to their promises?” to invest in UHC. 

National policy makers need to see health workforce as an investment – which will benefit economies and societies.  

“For us,  it is how to get that real political leadership. Not seeing health care investments as a cost, but as a fundamental intervention? 

“It’s very, very important for me, the question of advocacy, how do we advocate  to governments, to the leaders to see health as a necessary investment that must be made? 

“How do we get them to replace the negative working conditions for their practitioners? How do we get them to have very progressive mechanisms to retain them? And a lot of this has to be done even in the middle-income countries.” 

Role of industry 

Paula Head, lead of Roche’s  Policy, Value and Access

As head of a UK hospital during the pandemic, Paula Head saw plenty of exhausted health workers, mostly female, coming on duty while still exhausted from their last shift at the hospital.  

“But what I also saw during COVID was the most phenomenal ability to introduce innovation rapidly, effectively and safely, with the industry and the health services working closer together because we had a single focus – which was keeping the staff and their patients safe and well,” recounts Paula Head, formerly the head of a UK hospital during the pandemic, and now the Roche lead for Policy, Value and Access. 

“And so I wanted to continue that innovation journey but to do it from the private sector where I thought we could continue to make a difference. 

She sees self-testing as an example of one key area where industry can support innovation that eases the load for health workers and uses their skills more effectively to diagnose and treat a range of disease conditions. 

“We’re all familiar with self testing from COVID for doing and, of course, what that gives us is, first of all, the ability for patients to understand and manage their own health conditions. It also saves time from the phonetical physician having to take the test, send it to the lab, having to analyze the test, and so this really supports change in in the innovation and supports  the workforce. 

“Another example, done really effectively in Egypt, is end-to-end innovation in labs so that you can get a complete analysis from beginning to end, freeing up the lab workforce. 

“And then also another example I’d give is subcutaneous injection for cancer treatments.Most patients have to go through an infusion which takes many hours. The subcutaneous injection is injection under the skin; it takes much less time, which means that first of all, the patients aren’t having to stay in the hospital for long periods of time. It releases capacity, so enables those chairs to be available for people who absolutely do need an infusion. And it means that the products can be delivered in more remote areas because you don’t have to come to a specialist center for the treatment. 

“So those three are really good examples of how we’re moving technology and using innovation to support the health workforce.”

Using AI to improve health workforce performance 

Artificial intelligence innovations, when designed together with health workers, can empower them.

But these are innovations using the technology that are available now, she pointed out.

What’s need now is more collaboration between industry and health systems to anticipate and develop new solutions, she said. 

“Say we are looking at diagnosis. If we added in AI, and Roche is working on some of this now, we can move from diagnosis to prognosis and then from prognosis to stratification and targeting patients so that we use resources we’ve got for the patients where it can make the biggest difference. 

Still, she cautions that innovation best comes from the bottom up, rather than the other way  around. 

“We’ve got to work with governments to anticipate and understand what’s coming up and then find the right solution – rather than finding the solution that we think is right,” she asserted.

Added Mikkelsen, what’s also most needed is a refocusing of health care systems on the “multi-disciplinary teams” particularly in budget-strapped low-income countries. 

“Many of these countries has something similar to a primary health care service,” said Mikkelsen. “But it’s geared to HIV, TB and malaria because that is where the funding came from. And now we really need to see the whole person.”

Image Credits: Medtronics, E. Fletcher/HPW, E. Fletcher/ HPW, WHO / Blink Media, Neil Nuia, E. Fletcher/HPW , https://www.flickr.com/photos/mikemacmarketing/42271822770/.

Thousands of aid trucks are waiting to enter the Rafah crossing

A third convoy of 20 aid trucks with food, water and medical aid entered Gaza on Monday via Egypt’s Rafah crossing, in line with a  reported US-Israeli deal Sunday evening to keep desperately needed humanitarian aid flowing to the war-torn enclave. But no fuel has been allowed into the territory, and hospital generators are expected to run out by Wednesday, according to relief agencies.  

Israel is blocking fuel from entering Gaza as it claims Hamas will hijack fuel supplies to continue its missile attacks on Israeli cities, ongoing since the 7 October surprise incursion by Hamas gunmen into 22 Israeli communities, killing more than 1300 people, mostly civilians.  Israel has since cut off Gaza’s access to water and electricity from its grid, and bombarded the enclave at an unprecedented level of intensity.   

Now, the lives of Palestinian patients – including 130 premature babies dependent on hospital incubators – are at risk as fuel runs out, according to the UN Office for the Coordination of Humanitarian Affairs in the occupied Palestinian Territory.  Gaza’s desalinization plant is also dependent on fuel supplies to backup generators to produce clean water, since Israel cut off access to its electricity grid.  

Dr Tamer Al-Shaer, head of shelters in southern Gaza for the United Nations Relief Agency for Palestine (UNRWA), described the situation as “catastrophic” on Monday.

Nearly 420,000 people are sheltering in 93 UNRWA shelters in Middle, Khan Younis and Rafah areas, an increase of 14,000 (3.5%) in the past 24 hours, the UNRWA reported late Monday. 

This includes 3190 pregnant women and 18,000 with chronic conditions who need medical support, said al-Shaer.

Shelters are operating at 2.57 times their designated capacity, according to the relief agency.

Over 5,000 people have been killed in Gaza in the past two weeks, 40% of whom are children, according to Gaza’s Ministry of Health.

Meanwhile, UNRWA reported on Monday that 35 of its staff have been killed in Gaza since 7 October when Hamas first attacked Israel, unleashing an aerial bombardment of the territory by Israel in response.

The entry of the third convoy of trucks Monday means that 54 aid trucks have so far entered the territory from Egypt, in line with a deal on humanitarian aid reached with Israel during US President Joe Biden’s recent visit. But this is a drop in the ocean of need for an estimated 1.6 million Palestinians who are trapped and unable to leave the territory, UN officials say.

Before the 7 October conflict, 100 trucks delivered aid to the territory every day as almost a third of Gaza residents were food insecure even then.  

Five United Nations (UN) agencies, including the World Health Organization (WHO) and UNICEF, warned over the weekend that water production was at 5% of normal levels, food was running out and hospitals were overwhelmed with casualties.

“With so much civilian infrastructure in Gaza damaged or destroyed in nearly two weeks of constant bombings, including shelters, health facilities, water, sanitation, and electrical systems, time is running out before mortality rates could skyrocket due to disease outbreaks and lack of health-care capacity.

“We call for a humanitarian ceasefire, along with immediate, unrestricted humanitarian access throughout Gaza to allow humanitarian actors to reach civilians in need, save lives and prevent further human suffering. Flows of humanitarian aid must be at scale and sustained, and allow all Gazans to preserve their dignity,” said the statement, which made no reference to the fate of over 200 Israeli hostages held by Hamas along with foreign students and workers.

Meanwhile two more Israeli hostages, Nurit Cooper, 79 and Yocheved Lifshitz, 85, were released late Monday night to the Red Cross making four hostages to be freed over the past four days. They were among the 222 people originally seized, including young children and older people, during the 7 October deadly rampage by Hamas gunmen in 22 Israeli communities near Gaza. 

There has meanwhile been an escalation in violence in the West Bank. Some 95 people have reportedly been killed, mainly in confrontations between armed Palestinians and Israeli troops, but also in clashes with Israeli settlers. On Sunday, an Israeli airstrike hit al-Ansar Mosque inside Jenin Refugee Camp, according to UNRWA. Israeli said it was targeting a Hamas and Islamic Jihad compound under the mosque being used to organize an imminent attack, a claim that could not be independently verified. 

-Updated 24.10 with news of the latest hostage releases

Image Credits: Eskinder Debebe/ UN.

Dr Gaya Gamhewage, WHO Director of the Prevention of and Response to Sexual Misconduct (PRS) team and Lisa McClennon, Director of the WHO Office of Internal Oversight Services.

The vast majority of sexual misconduct complaints have been made in the World Health Organization’s (WHO) Africa region, while the majority of abusive conduct complaints originate in the Eastern Mediterranean Region (EMRO), which comprises mainly of countries in North Africa and the Middle East.

This is according to the WHO’s dashboard on investigations into sexual misconduct.

Abusive conduct refers to all misconduct, excluding sexual exploitation, abuse and harassment (for example, discrimination and bullying).

Acknowledging that “culture change” is hard, Dr Gaya Gamhewage, WHO Director of the Prevention of and Response to Sexual Misconduct (PRS) team said that “more personnel are speaking up” and the number of allegations and disciplinary action was increasing.

Soon every duty station and every person who works with and for the WHO will understand how to prevent and respond to sexual misconduct, Gamhewage told a media briefing on Monday.

Describing the WHO’s accountability framework as “the most detailed” across UN agencies, Gamhewage said that “everyone who works with or for WHO, including senior leadership all the way up to the Director General, now has very distinct accountabilities for both preventing and responding to sexual misconduct”. 

“It’s intended to clarify for every member of the organisation, from me to the driver in Malawi, their individual accountabilities for both prevention and response,” she told a media briefing on Monday.

Every country office is also obliged to run a risk assessment for sexual misconduct and come up with a mitigation plan.

“That’s how we can be sure that we quantify and qualify the risks of sexual misconduct at every single duty station. So the mitigation plans are important and they have to be suited to each context. So far this year, nearly 40 countries have completed this and this allows us really to be targeted and contextualised in our work,” said Gamhewge.

Lisa McClennon, the newly appointed director of the WHO’s Office of Internal Oversight Services (IOS), reported that the investigative team has received 287 allegations of sexual misconduct, of which 120 have been investigated and 38 have been substantiated so far. 

“Since 2021, we have entered the names of 25 alleged perpetrators of sexual misconduct into the UN Clear Check database to prevent future employment within the UN system,” added McClennon.

Open-door sessions

To encourage openness, Gamhewge said she was hosting monthly “open-door virtual sessions” and monthly workforce surveys of the workforce. 

Almost 10,000 people have taken part in PRS webinars and open-door sessions this year, and more than 60,000 others have taken their courses and training. 

“I’ve personally met with nearly 200 of our 407 Country focal points. We openly talk about issues. We address concerns staff have and staff are proposing ideas for our culture to change so that, not only do we respond, but we prevent sexual misconduct from happening in the first place. “

The PRS will host a stakeholder review at the end of November to “further calibrate the actions we need to take, going into year two [of the WHO’s  three-year 

“The global event will focus on acknowledging and identifying best practices for addressing sexual misconduct across the system and looking at the joint challenges that we all continue to face,” she added.

Aid trucks stuck outside Gaza.

UPDATED ( 22:30 CEST 22.10.2023) The first convoy of 20 trucks carrying humanitarian aid to besieged Palestinians, including four trucks of WHO emergency medical supplies, entered southern Gaza via Egypt’s Rafah crossing Saturday. 

Another aid convoy of 14 trucks, including food water and medical supplies, entered Gaza on Sunday, UN officials  confirmed. They expressed hopes the humanitarian corridor could remain open, even as questions remained over its continuation amidst the Israeli threat of a ground invasion of Gaza along with an expanding arc of regional hostilities, including on the Israeli-Lebanese border.

At the same time, Friday evening’s release of two American-Israeli hostages, including a mother and her daughter, held by Hamas raised hopes that behind-the-scenes negotiations could aid in further humanitarian efforts.

United Nations (UN) Secretary-General Antonio Guterres said that the UN was “actively engaging with all the parties in order to clarify [the aid] restrictions so we can have these trucks moving towards where they’re needed”.

Addressing the media in front of Egypt’s Rafah border crossing to Gaza on Friday afternoon, Guterres called for the speedy movement of the aid trucks.

 “We are witnessing a paradox. Behind these walls, we have two million people that are suffering enormously: that have no water, no food, no medicine, no fuel,” said Guterres. 

“On this side [of the border] we have so many trucks loaded with water, with fuel, with medicines, with the food. 

“These trucks are not just trucks. They are a lifeline. They are the difference between life and death for so many people in Gaza and to see them stuck here makes me be very clear. What we need is to make the move; to make them move to the other side of this wall, to make the move as quickly as possible, and as many as possible.”

UN Secretary-General Antonio Guterres addresses the media outside the Rafah border crossing in Egypt.

Intense negotiations

On Friday, Tamara Alrifai, Director of External Relations for the UN Relief and Works Agency for Palestine Refugees (UNRWA) said that she did not know “what is stopping the trucks but what we know is… everyone is calling for an immediate humanitarian ceasefire and an unimpeded, continuous and safe humanitarian access for humanitarian convoys”.

She added that there were “intense negotiations” about the aid trucks. 

“What is needed is a continuous flow of aid. This is not about a one-off sending 20 trucks and then nothing. This is really a call for continuous and safe humanitarian access with security conditions that allow my colleagues in Gaza to do what they need to do, which is check in on the internally displaced people (IDPs), run the health centres and distribute water and food.”

Earlier in the day, construction teams were seen working feverishly to repair the Rafah border entrance. which had been bombed in Israeli airstrikes earlier in the week, to enable the trucks could enter Gaza.

During a World Health Organization (WHO) briefing on Thursday, Dr Mike Ryan, head of health emergencies, decried the Israeli decision to only allow 20 trucks into the territory – and not to allow fuel urgently needed to power hospital generators and water desalination plants.

An AFP journalist reported that six fuel trucks, apparently destined to power hospital generators, had indeed entered Gaza as part of Sunday’s medical aid convoy. That was denied by Israel, which has said it believes fuel designated for humanitarian use has been filtered off to continue fueling the war.

“We have very, very detailed lists of the medical equipment and supplies that we’re sending, and they’re extremely well documented,” added Ryan at Thursday’s briefing, adding that these included amputation kits, intubation kits, pneumothorax kits to treat punctured lungs, and “many wound dressings, infusions, disinfectants, anaesthetics and painkillers”. 

However, Ryan added that the routes of the aid trucks had to be “de-conflicting” to ensure that “the trucks are not attacked or disrupted in any way, and that the goods can be offloaded safely”.

“Bringing supplies through a border crossing and for humanitarian assistance requires security planning, logistics planning. It is best done with people on the ground and is best done with independent monitoring of the delivery, and we do that in countries all over the world and in very difficult humanitarian situations and in zones of actual conflict,” added Ryan.

Guaranteed ‘deconfliction’

Ryan stressed that the combatants carrying out the hostilities had to guarantee “deconfliction”.

The fact that Israel had only allowed 20 trucks was a “drop in the ocean of need right now in Gaza”, Ryan stressed.

He asked how the WHO was supposed to choose whether to prioritise water, food or essential medicines.

“You get to send 20 trucks into a situation where two and a half million people are thirsty, without food, without water, without medicine,” said Ryan. 

“It shouldn’t be 20 trucks, it should be 2000 trucks. And we shouldn’t have to be making these choices.”

Meanwhile, Israel has continued its airstrikes of Gaza and is currently massing troops on Gaza’s border in preparation for a ground offensive, while Hamas continued missile fire on southern and central Israel.

In a briefing to parliament on Friday, Israeli Defence Minister Yoav Gallant said that the final phase of the current miliary offensive would be the “removal of Israel’s responsibility for life” in the Gaza Strip.

On Friday, the Palestinian Red Crescent Society said Israel ordered the evacuation of Gaza’s Al Quds Hospital, which is treating some 400 patients and is providing sanctuary to an estimated 12,000 displaced people.  But Israel later denied that there had been an order to evacuate the hospital – although the army has called for all civilians and hospital activities in northern Gaza to move south.  AFP, which had reported on the evacuation call later withdrew its story.

Elaine Ruth Fletcher contributed to reporting on this story.