President Donald Trump’s first day in office saw a barrage of executive orders aimed at dismantling US climate policy, boosting fossil fuel production and undercutting green energy technologies.

Hours after reclaiming the presidency, Donald Trump moved swiftly on Monday to withdraw the United States from the Paris climate agreement and unleash a barrage of executive orders aimed at dismantling US climate policy, boosting fossil fuel production, and undercutting green energy technologies.

The sweeping actions, which are expected to trigger months of legal challenges from states, cities, and environmental groups test the limits of executive authority to reshape national climate policy. They also mark a dramatic reversal of American climate action that threatens to undermine global efforts to combat warming.

The actions, including orders to clear the way for fossil fuel infrastructure expansion and eliminate government support for clean energy technologies from electric cars to wind power, will once again make the United States one of only four nations — alongside Iran, Libya and Yemen — to stand outside the landmark Paris climate accord signed by 196 countries.

“The United States has purported to join international agreements and initiatives that do not reflect our country’s values,” Trump said in one executive order, describing the Paris agreement as a “rip-off.”

Trump also terminated the US International Climate Finance Plan, ending American support for developing nations fighting climate change. The move cuts off $9.5 billion in annual climate funding — representing just 0.147% of the U.S. federal budget — that the Biden administration had scaled up from $1.5 billion to support frameworks like the Green Climate Fund and Global Environment Facility.

“These agreements steer American taxpayer dollars to countries that do not require, or merit, financial assistance in the interests of the American people,” Trump said.

CO2 emissions from Trump policies could ‘negate’ global clean energy gains

Solar panels being affixed to a hospital in Alberton, South Africa. New US emissions generated by Trump policies could negate gains of renewables deployed over past five years.

The withdrawal process will take a year to complete, but its effects could be far more immediate and lasting. An analysis by Carbon Brief projects that a second Trump term would generate an additional four billion tonnes of carbon dioxide emissions over four years — enough to negate “twice over” all the emissions reductions achieved through global clean energy deployment in the past five years.

And that comes against the specter of a rapidly warming climate.  Earlier this month, the EU Copernicus weather service declared 2024 the hottest year on record and the first to breach the 1.5-degree Celsius warming threshold that the Paris agreement aimed to prevent. Scientists warn the world is now tracking toward 3.1 degrees of heating by century’s end, risking catastrophic impacts for billions around the globe.

The orders represent a sharp departure from the Biden administration’s climate agenda. In December, President Biden unveiled plans to cut US greenhouse gas emissions by more than 60% by 2035 and had increased American international climate funding sixfold to $9.5 billion annually.

Trump’s directive also freezes all US foreign development aid for 90 days, citing a “foreign aid industry and bureaucracy” that he claims works against American interests. The freeze could affect critical programs like the World Food Programme, where the United States serves as the largest donor, at a time when climate-related drought and hunger is on the rise, along with conflicted-related hotspots such as Gaza and Sudan.

Swift international criticism

European Commission President Ursula von der Leyen pledges “Europe will stay the course” in the fight against climate change.

The Trump administration’s moves drew swift international criticism, particularly from developing nations that are most vulnerable to climate impacts while contributing least to global emissions.

“This threatens to reverse hard-won gains in reducing emissions and puts our vulnerable countries at greater risk,” said Evans Njewa, chair of the Least Developed Countries group, which represents 45 nations and 1.1 billion people. The bloc’s members account for less than 1% of global emissions despite comprising about 14% of the world’s population.

At the World Economic Forum in Davos, European leaders vowed to maintain their climate commitments even without American participation.

“All continents will have to deal with the growing burden of climate change. Its impact is impossible to ignore,” said Ursula von der Leyen, the European Commission president. “The Paris Agreement continues to be humanity’s best hope. Europe will stay the course.”

Human health toll of US withdrawal

Trucks and buses spew out soot, including climate-changing black carbon and health harmful PM2.5.

The human health cost of the US withdrawal could be severe. The World Health Organization estimates that urgent climate action could save two million lives annually, including over one million from reduced air pollution alone. And with every degree of temperature increase, approximately one billion people will be pushed outside the climate niche where humans have lived for millenia.

“The most tragic consequences will be felt in developing countries,” said Harjeet Singh, policy lead at the Fossil Fuels Non-Proliferation Treaty. “These vulnerable nations and communities, which have contributed the least to global emissions, will bear the brunt of intensifying floods, rising seas and crippling droughts.”

The World Economic Forum estimates the global cost of climate change damage will reach between $1.7 trillion and $3.1 trillion annually by 2050. But Simon Stiell, head of the United Nations climate body UNFCCC, warned at Davos that climate concerns are being overshadowed by other global crises.

“We only seem to have the attention span for one crisis at a time,” Stiell said. “The science behind climate hasn’t changed, the impacts actually have changed, in that they are getting worse and worse.”

No country followed the United States in abandoning the Paris Agreement during Trump’s first withdrawal in 2017, which took three years to complete and was immediately reversed when President Biden took office in 2021. But climate experts also worry that a second US exit could have broader ripple effects on global climate cooperation and financing at a crucial moment for planetary action.

G20 president Cyril Ramaphosa, also speaking from Davos, captured the mounting concern: “This is a time of rising geological geopolitical tensions, unilateralism, nationalism, protectionism and isolation… Yet this is a moment when we should be standing together as the global community. We are called upon by the exigency of the moments to act together with greater urgency to halt the destruction of our planet.”

Withdrawing from Paris Agreement was just the beginning

Even before Trump’s election, US oil and gas production had reached record highs, even as wind and solar outpaced coal power generation for the first time ever, as well.

The withdrawal from the Paris Agreement was just the tip of the melting iceberg of Trump’s energy and climate policy overhaul. In a series of executive orders, he declared a “national energy emergency” and vowed to “unleash American energy,” despite the fact that the United States isn’t facing energy shortages at all.

In fact, the Biden administration had already let both oil and natural gas production rise to historic highs. Throughout Biden’s term, the US, the world’s largest historical GHG emitter, remained second-largest emitter behind China. Trump, however, claimed that “climate extremism has exploded inflation and overburdened businesses with regulation.”

His orders included lifting moratoriums on natural gas export permits and approving oil and gas drilling in Alaska’s Arctic National Wildlife Refuge, one of America’s last pristine wilderness areas.

Trump also ordered a freeze on offshore wind development, stating “we’re not doing that wind thing,” while directing federal agencies to expedite fossil fuel infrastructure projects and freeze Biden-era funding for clean energy technologies.

“We have something that no other manufacturing nation will ever have, the largest amount of oil and gas of any country on Earth, and we are going to use it,” Trump declared in his inaugural address. “We will be a rich nation again, and it is that liquid gold under our feet that will help to do it.”

The push for increased production comes at an uncertain time for global energy markets. International oil demand has plateaued, and many American energy companies have expressed reluctance to significantly boost output, concerned that oversupply could drive down prices and squeeze profits. US oil prices fell around 1% on Monday as details about Trump’s energy plans emerged.

Fossil fuel industry celebrates

Oil refinery in Big Spring, Texas.

The fossil fuel industry, which donated $75 million to Trump’s campaign, celebrated the policy changes at a gathering in the Hay-Adams Hotel attended by leading oil and gas executives and hosted by Harold Hamm, the billionaire founder of Continental Resources, the New York Times reported.

American fossil fuel companies have known about climate change impacts for over five decades while publicly downplaying risks and advocating for continued production. Global fossil fuel companies have recorded a combined $3 billion in profits every day for the past 50 years.

“American success relies on American chemistry,” said Chris Jahn, President of the American Chemistry Council, a powerful lobby group representing fossil fuel and petrochemical manufacturers including ExxonMobil and Chevron. “Working with the Trump Administration and 119th Congress we can expand US chemical production and help keep America strong.”

Trump’s cabinet nominations further signal his fossil fuel agenda. His pick for Energy Secretary, Chris Wright, heads the world’s largest fracking company and has declared on LinkedIn that “there is no climate crisis, and we’re not in the midst of an energy transition, either.” The president himself has previously called climate change a “hoax” orchestrated by China.

For the Environmental Protection Agency, Trump has nominated Lee Zeldin, who during eight years in Congress consistently opposed environmental and climate policies. Zeldin has already outlined plans to reduce regulations, including air pollution standards.

In parallel, a rollback of energy efficiency regulations on everything from dishwashers to vehicle tailpipe emissions standards was also part of Monday’s executive orders – effectively allowing the production of more polluting vehicles. Monday’s executive orders also repealed Biden-era subsidies for electric vehicles — decisions that clean air advocates say could have serious public health implications.

AI and tech applications demand more power

Global data centre energy consumption is set to match India, the world’s most populous nation and third largest polluter, by 2035.

But even if the country appears to be awash in oil and gas, the declaration of a “national energy emergency”, however, was also being driven by another sector – the soaring power demands of technology, including artificial intelligence (AI).

After 15 years of relative stability, US energy demand is surging, driven largely by the proliferation of data centres as tech giants race to develop increasingly powerful AI systems. The US data centre boom has stretched the country’s dated power grids, delayed the retirement of coal plants and catalysed concerns that: America is running out of power.

Global projections suggest data centre energy consumption could reach 1,580 terawatt hours by 2034, roughly equivalent to the total electricity usage of India, the world’s most populous nation. This would make data centers collectively the world’s third-largest energy consumer, outpacing the 27-member European Union, if they were counted as a country.

Already today, data centres worldwide consume more electricity combined than all but 15 countries globally.  US data centres will comprise 8% of national electricity usage by 2035, according to an analysis by Goldman Sachs, which described the boom as “the kind of electricity growth that hasn’t been seen in a generation.”

A White House official speaking to reporters on Monday confirmed that the energy emergency declaration was partly motivated by viewing AI as a national security priority and the resulting need to expand the energy grid. The administration’s focus on AI was underscored by the announcement of $500 billion in new funding for artificial intelligence development — more than 55 times the amount cut from international climate finance.

Tech oligarchs stand to benefit

At the inauguration ceremony, a row of tech industry billionaires including Elon Musk, Sundar Pichai, Tim Cook, Mark Zuckerberg, and Sam Altman occupied prime seats in the Capital Rotunda, positioned more prominently than several incoming cabinet members.

The seven tech leaders present at the inauguration standing to benefit from the mass expansion of US power consumption command a combined personal fortune of $371.9 billion — enough to fund more than a year of global climate finance commitments. Their companies’ combined annual revenue of $1.39 trillion dwarfs the world’s promised climate funding target of $300 billion agreed in November at COP30 in Baku by nearly five times.

States and cities vow to fight back

“We’re building an implementation plan that meets our targets under the Paris Agreement and ensures that our cities remain resilient and prosperous for future generations,” Gina McCarthy, co-chair of America Is All In, said in a statement.

Even so, the sweeping executive orders issued in Mr. Trump’s first hours as president are already facing resistance, with questions emerging about both their legal standing and economic wisdom.

Legal experts suggest the “national energy emergency” declaration could face court challenges if the administration cannot demonstrate conditions that justify bypassing standard environmental review procedures. But the more immediate resistance will come from within the United States itself.

America Is All In, a climate coalition representing nearly two-thirds of the US population and three-quarters of US GDP, has pledged to maintain climate action despite the federal retreat. According to Public Citizen, state and local government initiatives alone could achieve nearly 75% of US climate goals under the Paris Agreement.

“By leaving the Paris Agreement, this Administration is abdicating its responsibility to protect the American people and our national security,” said Gina McCarthy, co-chair of the alliance and former national climate advisor to President Biden. “But rest assured, our states, cities, businesses, and local institutions stand ready to pick up the baton of US climate leadership.”

Abandoning climate leadership could be costly to the US in the long run

Critics also argue that abandoning climate leadership could prove costly to the US in the emerging global green economy. With sustainable production projected to triple to $2 trillion by 2035, according to the International Energy Agency, many analysts increasingly view the shift toward clean energy as irreversible, driven by falling costs and improving technology.

As the US reverses course, the European Union and China continue to accelerate their transition to cleaner and greener technologies. France recently achieved 95% renewable power on its grid in 2024 as nuclear and clean energy sources displaced fossil fuels. China has leveraged massive state investment to dominate the renewable energy supply chain, while the E.U. has implemented ambitious emissions reduction targets and green technology incentives.

China has already established dominance through state investment, controlling over 80% of solar panel production – including half of US domestic production – and 76% of electric vehicle manufacturing. The country has cornered the market on rare earth minerals crucial for green technology, managing 70% of extraction and 90% of processing, according to Oxford University research.

Walking away from the Paris Agreement will hand China and EU a competitive edge

“Walking away from the Paris Agreement won’t protect Americans from climate impacts, but it will hand China and the European Union a competitive edge in the booming clean energy economy,” said Ani Dasgupta, president of the World Resources Institute.

“If the Trump administration truly wants America to lead the global economy, become energy independent, and create good-paying American jobs,” Ms. McCarthy added, “then they must stay focused on growing our clean energy industry. And if they want to be tough on China, don’t punish US automakers and hard-working Americans by handing our clean car keys to the Chinese.”

 ‘Red’ states could oppose Trump’s plans to rollback IRA investments

Republican-controlled districts receive 85% of Inflation Reduction Act funding, presenting a potential roadblock for Trump’s efforts to cut funding, according to reporting by journalism consortium Investigate Midwest.

Trump’s ability to completely unwind America’s climate initiatives faces significant obstacles in another, unexpected quarter – and that is among US states that have benefited from federally-subsidized investments in electric car production and renewable energy grids, thanks to the Inflation Reduction Act.

The Biden administration has already finalized contracts for $96.7 billion — or 84% — of the law’s clean energy grants. These include $8.8 billion for state energy-efficiency programs, $3 billion for reducing port pollution, and $9 billion to help rural electric providers transition from fossil fuels to alternatives like wind, solar, and nuclear power.

While approximately $11 billion in grants remain unfinalized, including funds for agricultural conservation and pollution reduction in disadvantaged communities, the law’s implementation is well advanced.

So his executive order for federal agencies to pause and review grant spending under the Inflation Reduction Act may have come too late to have its intended effect.

Even more significantly, 85% of the IRA’s funding has been invested in majority-Republican districts, drawing new firms and jobs to economically underprivileged areas. That, observers say, creates a potential political firewall against attempts to undo the legislation.

The economic stakes are also considerable. Analysis by Johns Hopkins University suggests that unwinding US climate policies could result in $50 billion in lost revenue for US companies and up to $80 billion in lost investment opportunities that competing nations stand ready to capture. This economic reality, combined with the IRA’s bipartisan benefits, may make a full repeal politically unpalatable, even if the administration pushes for one.

 “The community that believes in, endorses, underpins that [climate] science is far, far more significant than those few voices that challenge,” Stiell, the UNFCCC chief, said. “The science has been weaponized, and that’s reflective of the politics.”

Image Credits: Flickr: Radek Kucharski, UNEP, Carbon Brief , James St. John, Investigate Midwest.

Donald Trump gives a speech in Arizona, the state with one of the fastest rising coronavirus caseloads in the US, on 23 June 2020.

United States President Donald Trump may face a lawsuit over his failure to get the approval of US Congress to withdraw from the World Health Organization (WHO).

“Trump made a unilateral decision to pull out of WHO. But we joined WHO in 1948 by an Act of Congress. Trump needs Congress’ approval to withdraw,” said Professor Lawrence Gostin, who directs the  O’Neill Institute and is the Chair of Global Health Law at Georgetown University in Washington DC.

“His decision is too catastrophic to be made without Congress and the courts. As director of a WHO Center, I am considering a lawsuit,” added Gostin, who also heads the WHO Center on Global Health Law.

Meanwhile, German Health Minister Karl Lautenbach wants to persuade Trump to change his mind, describing the decision as “a catastrophe for the poorest people on the planet” who need WHO support, such as those in Gaza.

The US is obliged to give a year’s notice of its intention to withdraw from the WHO, yet Trump’s Executive Order directs State officials to “take appropriate measures, with all practicable speed” to “pause the future transfer” of US of government “funds, support, or resources to the WHO”.

The order also recalls all US “personnel or contractors working in any capacity with the WHO”.

A senior WHO official told Health Policy Watch that “it has been a long night”, but that the UN health agency will survive if all its remaining 193 member states stick together in the coming days. The tiny European monarchy of Liechtenstein is the only other country that is not part of the WHO.

China ‘rationale’

Trump’s rationale for withdrawing from the WHO is the same as he advanced during his first presidency: WHO’s “mishandling” of the COVID-19 pandemic, its “failure to adopt urgently needed reforms”, and its “inability to demonstrate independence from the inappropriate political influence of WHO member states” – primarily China.  

Trump also noted that the WHO “continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments”, such as that of China.

Of the 196 WHO member states, the US is by far the largest funder. It is due to pay nearly $261 million in “assessed contributions” (membership fees) during 2024/5.  

US contribution to WHO in 2023

China, the second-largest contributor in terms of assessed contributions, is only due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates.

 

China’s contribution to WHO in 2023

While blaming the WHO for mishandling COVID-19, it is worth remembering that US Republicans died of COVID-19 at a significantly higher rate than Democrats, in all likelihood because of the anti-vaccine rhetoric and confusing treatments being suggested by Trump and his party.

After the introduction of COVID-19 vaccines, the excess death rate amongst Republicans was 10.4% higher than that of Democrats, according to a study published in the American Journal of Public Health.

Between January 2018 and December 2021, there were 15% more COVID-19 deaths amongst Republicans in Florida and Ohio than Democrats, ballooning to a 43% higher excess deaths amongst Republicans once vaccines were introduced, according to a 2023 study in JAMA Internal Medicine.

Excess Death Rates and Vaccination Rates in Florida and Ohio During the COVID-19 Pandemic

WHO asks Trump to ‘reconsider’

In a measured response, the WHO said that it “regrets” the decision and hopes the US will “reconsider”.

“We look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe,” the WHO stated.

“WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.”

It also noted that the US was a founding member of WHO in 1948 and assisted in saving “countless lives”, ending smallpox and bringing polio to the “brink of eradication”. 

The WHO also noted that, in the past seven years, it has “implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries”.

In 2022, the World Health Assembly adopted in full recommendations for financing reform made by the Sustainable Financing Working Group, which also include proposals to increase the body’s efficiency, as previously reported by Health Policy Watch.

US condemnation

Dr Tom Frieden, CEO of Resolve to Save Lives, said that Trump’s decision makes Americans and the world less safe and increases “the risk of a deadly pandemic”.

“The plain truth is that WHO is irreplaceable. WHO’s track record demonstrates its value to the world. The historic US-Soviet collaboration through WHO to eradicate smallpox – one of humanity’s greatest achievements – shows how cooperation on global health can transcend political differences to protect everyone,” said Frieden, a former head of the US Centers for Disease Control and Prevention.

“Withdrawing from WHO not only cuts crucial funding from the agency, but it also surrenders our role as a global health leader and silences America’s voice in critical decisions affecting global health security,” he added.

“Real reform requires engagement, not abandonment. We cannot make WHO more effective by walking away from it.”

Physicians for Human Rights executive director Sam Zarifi said that the withdrawal “needlessly, heedlessly, endangers the tremendous advances in global public health over the last century” as “diseases respect no borders and demand global collaboration”. 

US domestic health is also under fire

US domestic health measures were also the target of the swathe of executive orders signed by Trump on Monday, reports Stat.

Trump rescinded Biden-era orders aimed at lowering medicine costs for Medicare and Medicaid, expanding access to the Affordable Care Act, COVID-19 treatments and vaccines, as well as various protections for race, gender and sex discrimination.

Foreign aid is frozen

Trump has also frozen US foreign aid for 90 days in an executive order aimed at “re-evaluating and realigning” aid.

“All department and agency heads with responsibility for United States foreign development assistance programs shall immediately pause new obligations and disbursements of development assistance funds to foreign countries and implementing non-governmental organizations, international organizations, and contractors pending reviews of such programs for programmatic efficiency and consistency with United States foreign policy, to be conducted within 90 days of this order,” according to the order.

Excerpt from Trump’s executive order on foreign aid 2025

The rationale given is that the “foreign aid industry and bureaucracy are not aligned with American interests and in many cases antithetical to American values”.  

Furthermore, they “serve to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations internal to and among countries”.

The controversial right-wing blueprint for Trump’s victory coordinated by the Heritage Foundation, Project 2025, proposes that all US aid including humanitarian assistance, is conditional on the rejection of abortion.

“Proposed measures for USAID [US Agency for International Development] include a significant restructuring, and reduction of budget, the removal of diversity, equity, and inclusion programs, and dismantling of the apparatus that supports gender equality and LGBTQ+ rights,” notes researcher Malayah Harper in an analysis of Project 2025.

So far, Trump is following the mandate of Project 2025 despite feigning ignorance about it during his election campaign.

Image Credits: Gage Skidmore, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2807617#google_vignette.

President Donald Trump has signed an executive order to withdraw the United States from the World Health Organization (WHO), citing its handling of the COVID-19 pandemic and other global health crises.

Trump criticised the WHO for failing to operate independently of what he called “inappropriate political influence” from its member states. He also took issue with the financial burden on the US, the organization’s largest contributor, providing about 18% of its total funding.

“The World Health Organization has taken advantage of us, just like everyone else,” Trump said during the signing. “That stops now.”

The WHO responded by expressing “regret” over Trump’s decision and reminding the administration that America was a founding member of the organisation in 1948 and has helped shaped WHO’s work ever since.

“For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people from health threats,” the organisation said in a statement. “Together, we ended smallpox, and together we have brought polio to the brink of eradication. American institutions have contributed to and benefited from membership in WHO.”

The organisation stressed the role it plays in protecting health and security for everyone, including Americans, “by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.”

The withdrawal will take effect in 12 months, with the US ceasing all financial contributions to the agency’s $6.8 billion 2024–2025 budget. Trump argued that the organisation demanded “unfairly excessive payments” from the U.S., especially compared to contributions from other major nations, such as China.

This is a developing story.

Moment at which three Israeli hostages, Doron Steinbrecher, Romi Gonen and Emily Damari, are turned over by Hamas to the Red Cross in Gaza City on Sunday.

WHO welcomed Sunday’s Israel-Hamas ceasefire and hostage release deal as the first Israeli hostages – three young women – were released to the Red Cross amidst throngs of masked Hamas operatives, who brandished guns atop the Red Cross vehicles and fired shots at times into the air to ward off the crowds of people that gathered to watch the handoff in Gaza City. 

The Israeli hostage release, followed by Israel’s release of some 90 Palestinian prisoners, all women and minors, came as the shaky ceasefire deal took effect on Sunday. 

The deal ushered in a 42-day halt in the fighting and a partial Israeli military withdrawal away from Gaza’s dense population centers and parts of Gaza’s Rafah crossing to Egypt – which is supposed to be accompanied by a massive surge in humanitarian aid.  The six week-long period is supposed to see the release of some 33 Israeli hostages in all, including remaining women, children and elderly hostages, some already presumed dead, along with more than 1700 Palestinian prisoners from Israeli jails.  

Negotiations that will continue during the first phase are supposed to lead to a second stage, including what Qatari mediators have described as a complete Israeli military withdrawal from Gaza and the release of the remaining 65 Israeli and foreign hostages, all men, as well as several thousand more Palestinian prisoners in Israeli jails. 

“The ceasefire in #Gaza and the start of the hostage and prisoner release process bring great hope for millions of people whose lives have been ravaged by the conflict,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in an X post. “It is a moment I have been calling and hoping for.”   

“However, addressing the massive health needs and restoring the health system in Gaza will be a complex and challenging task, given the scale of destruction, operational complexity and constraints involved,” said Tedros, citing a lengthy WHO statement focused on the challenges of Gaza reconstruction. 

garbage accumulates in gaza, raising risk of polio
Tent camps of displaced Gazans amidst piles of garbage, and contaminated water supplies, raises infectious disease risks.

WHO European Region release separate statement on Israeli hostages release

In a separate statement,  WHO’s European region welcomed the release of “WHO welcomes the release of traumatized hostages taken from Israel, after enduring 470 days of brutal captivity in Gaza.” 

It was a rare WHO statement on the hostage situation in a conflict where the deaths of over 46,000 Palestinians in Gaza, and it’s near physical destruction, has overshadowed the plight of Israeli hostages held by Hamas since their bloody 7 October, 2023 incursion into Israeli border communities that killed nealry 1200 people and took over 240 captive. 

“WHO is acutely aware that the hostages face complex mental and physical health needs and may take years to recover. The families of hostages also require sensitive mental health care,” said the WHO European Region statement.

“WHO is reassured that Israel – a WHO/Europe Member State – possesses the resources and relevant expertise to respond to the medical, mental, and nutritional challenges to restore the health of the hostages, and the well-being of their families.

“In Gaza, WHO and partners are scaling up operations to deliver critical medical supplies and resources, addressing urgent health needs and contributing to recovery efforts including the process of rebuilding the shattered health system,” the WHO European statement also said. 

“We reaffirm our readiness to support affected communities on all sides.”

Fears of potential breakdown in ceasefire running high

Fears about a potential breakdown in the ceasefire arrangements have been running high on all sides as armed Hamas fighters emerged from refugee encampments and hospital compounds in a visible display of force. Meanwhile, Israel’s hard-right politicians vowed that the country would return to fight Hamas in Gaza to its total destruction, following the initial six-week cease fire period. 

A third phase of the cease fire deal, if finalized,l is supposed to see a permanent cessation of the conflict, opening the way for the massive task of rebuilding Gaza’s shattered housing, education, water and sanitation infrastructure.

It’s estimated that more than 90% of the enclave’s two million Palestinians have been displaced from their homes – many of which no longer exist at all.  

And rebuilding the health infrastructure, alone, will cost an estimated $10 billion, according to initial estimates by WHO, with only about one-half of the enclaves hospital’s functioning, even partly, and most of the primary health care system destroyed.

“More than 46 600 people have been killed and over 110 000 have been injured. The real figures are likely much higher,” the WHO HQ  statement noted. “Only half of Gaza’s 36 hospitals remain partially operational, nearly all hospitals are damaged or partly destroyed, and just 38% of primary health care centres are functional.

“An estimated 25% of those injured – around 30 000 people – face life-changing injuries and will need ongoing rehabilitation. Specialized health care is largely unavailable, medical evacuations abroad are extremely slow. Transmission of infectious diseases has massively increased, malnutrition is rising, and the risk of famine persists. The breakdown of public order, exacerbated by armed gangs, raises further concerns.”

Indeed, the elephant in the room remains the governance of Gaza. In his final press conference last week, outgoing US Secretary of State Anthony Blinken, a key architect of the deal, said that Gaza should not be left in Hamas hands, leaving Israel open for future missile attacks and border threats such as the ones experienced on 7 October 2023 and since. 

That stance has been echoed by members of new US President Donald Trump’s incoming administration. But much-discussed proposals for turning Gaza’s governance over to a regional coalition or back to the internationally-recognized Palestinian Authority have failed to pick up steam – partly due to the PA’s own record of corruption and ineffectual government, as well as it’s lack of regional political support.

And so as the fragile cease-fire took hold, the Islamist group that has controlled the 365 square kilometer enclave for nearly 20 years, remains the only visible Palestinian force on the ground.

Image Credits: @nabilajamal, UNRWA .

Health workers during a Marburg outbreak

Tanzania has confirmed an outbreak of Marburg virus disease in the northwestern Kagera region after one case tested positive for the virus following investigations and laboratory analysis of suspected cases of the disease. 

Tanzanian President Samia Suluhu Hassan announced this during a press briefing on Monday with World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. 

“Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected with the Marburg virus. Fortunately, the remaining suspected patients tested negative,” the president said from the country’s capital, Dodoma. 

A total of 25 suspected cases have been reported, all of whom have tested negative and are currently under close follow-up, the president said. The cases were reported in Biharamulo district in Kagera. 

“We have demonstrated in the past our ability to contain a similar outbreak and are determined to do the same this time around,” added the president. “We have resolved to reassure the general public in Tanzania and the international community as a whole of our collective determination to address the global health challenges, including the Marburg virus disease.”

Last week, Tanzanian health authorities disputed a WHO report of a suspected outbreak, noting that five suspected cases had tested negative in its laboratories.

Emergency funds

Tedros announced that he has made $3 million available from the WHO Contingency Fund for Emergencies to assist Tanzania in addressing the outbrea, and pledged the WHO’s support for the country.

“Since the first suspected cases of Marburg were reported earlier, Tanzania has scaled up its response by enhancing case detection, setting up treatment centres and a mobile laboratory for testing samples, and deploying national response teams,” Tedros told the media briefing.

“Tanzania has gained strong experience in controlling Marburg as this is the second reported outbreak of the disease in Kagera. The first outbreak was almost two years ago, in March 2023, in which a total of nine cases and six deaths were reported,” he added.

The Africa Centres for Disease Control and Prevention (Africa CDC) also pledged support for the country.

“ A team of 12 public health experts will be deployed as part of an advance mission in the next 24 hours. The multidisciplinary team includes epidemiologists, risk communication, infection prevention and control (IPC), and laboratory experts to provide on-ground support for surveillance, IPC, diagnostics, and community engagement,” said Africa CDC.

“To support the government’s efforts, we are committing $2 million to bolster immediate response measures, including deploying public health experts, strengthening diagnostics, and enhancing case management,” said Africa CDC Director General Dr Jean Kaseya.

“Building on Tanzania’s commendable response during the 2023 outbreak, we are confident that swift and decisive action, combined with our support and those of other partners, will bring this outbreak under control.”.

Marburg virus, a highly infectious and often fatal disease, is similar to Ebola and is transmitted to humans from fruit bats. It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.

Although several promising candidate medical countermeasures are currently undergoing clinical trials, there currently is no licensed treatment or vaccine for Marburg. 

However, early access to treatment and supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival. 

Previous outbreaks and cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, Rwanda, South Africa and Uganda.

Image Credits: WHO.

Dr Matshidiso Moeti, outgoing Africa regional director

The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. 

This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board.

According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February.

A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board.

Fast-tracked

The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations.

Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. 

“This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week.

“If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed.

However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution.

The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges.

Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee.

The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva.

Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022.

Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC).

Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership.

Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health.

How do you define “white saviorism?”

According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.”

This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them.

In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said.

Quote by Themrise Khan on the Global Health Matters podcast
Quote by Themrise Khan on the Global Health Matters podcast

Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan.

Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system.

Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations.

One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded.

“The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said.

So, is there hope for change?

While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.”

Listen to more Global Health Matters podcasts on Health Policy Watch >>

Image Credits: TDR | Global Health Matters Podcast.

Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024.

As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny.

Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. 

Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi.

This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. 

Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment.

SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position.

In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”.

Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO.

“But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote.

Wazed is a psychologist with a special interest in autism.

Code of conduct

The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. 

It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment.

In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities.  We would not comment on such investigations or any consequential legal processes while they are ongoing.”

According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”.

A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so.

Image Credits: X, X/Saima Wazed.

A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents.

Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday.

The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024.

“We seem to be living in one of the most divided times since the Cold War,” the report notes.

“Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”.

The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. 

Current risks

State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. 

“The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes.

The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes.

“Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks.

“The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.”

In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”.

Conflict over Taiwan also cannot be ruled out, it notes.

“The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns.

Extreme weather events and “geo-economic confrontation” are the next biggest current concerns.

Short-term risks

Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”.

The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”.

Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk.

To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies.

Longer-term risks

Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings.

There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed.

The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents.

While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat.

Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes.

Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes.

“Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF.

“Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.”

Global fragmentation

However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”.

But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration.

“Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.”

Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions.

Image Credits: UNICEF/UNI501989/Al-Qattaa.

Obesity is growing fastest among children and adolescents

Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms.

So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology.

There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease.

The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity.

It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness.

All-or-nothing

“The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says  commission chair Professor Francesco Rubino.

“Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London.

“Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. 

“On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.”

Nuanced approach

The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. 

The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and  adolescents. 

These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints.

Pre-clinical obesity is defined as “obesity with normal organ function”. 

“People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission

BMI limitations

Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”.

“Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel.

“But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US.

“Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” 

Appropriate care

“This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia.

Image Credits: Commons .