Alzheimer's dementia tanzania
Hadija Kisanji, 78, who suffers from dementia sits with her daughter Mariam and grandchildren.

Africa’s population over the age of 60 will triple by 2050, bringing “a sharp rise in neurodegenerative diseases, including Alzheimer’s, with profound health and economic costs”, according to a paper published in Nature last week.

The paper highlights a five-year strategy, headed by a pan-African task force, to address this demographic shift on the continent, focusing on “early detection, timely care, data-driven systems, and equitable innovation”.

Some three-quarters of people living with Alzheimer’s globally are undiagnosed, denying them access to appropriate treatment and care. 

Given widespread systemic weaknesses in the health systems of several African countries, this may well be the fate of many of the estimated 226 million Africans over 60 projected to be living on the continent by 2050 (up from 69 million in 2017). 

Currently, only 12 African countries submit data to the Global Dementia Observatory.

Tunisia, Algeria and Egypt already have some of the highest dementia-related disease burdens in the world, and by 2050, 14 million Africans are expected to develop Alzheimer’s and related disorders. 

Health system transformation

The “6×5” plan developed by the Davos Alzheimer’s Collaborative (DAC) aims to assist African countries to address this growing problem using low-cost innovations.

It comprises six interventions over the next five years: strengthening advocacy and health literacy; positioning brain health as a socioeconomic driver; breaking down silos of people and data; repurposing local resources; investing in artificial intelligence and digital health, and boosting research funding. 

Advocacy and health literacy

“In many African cultural settings, dementia is often linked to madness, witchcraft and demonic possession, or it is dismissed as a natural part of ageing,” the report notes.

To address this stigmatising approach, it proposes health literacy campaigns aimed at establishing dementia as “a biological issue that requires immediate attention”. 

Brain health as a socio-economic driver

“Positioning brain health as a cornerstone of Africa’s societal well-being, economic growth and sustainable development is imperative,” according to the plan.

It calls for health policy makers to recognise brain health as a critical economic priority, and address individual and societal determinants of brain health across people’s entire lifespans.

This would start with the first 1,000 days of life, a critical phase for brain development, and include childhood education to build cognitive skills and lifelong learning opportunities.

It would also encompass women’s health initiatives to address gender disparities, initiatives to promote emotional resilience, and healthy ageing strategies that incorporate physical activity, nutrition and social engagement.

“The continent has a deeply rooted heritage of social connectedness, collective identity and intergenerational support – factors shown to promote cognitive well-being and mitigate cognitive decline,” the report notes.

Worldwide projections of Alzheimer's prevalence
Alzheimer’s disease is projected to affect over 106 million people by 2050

Repurposing local resources

“The continent needs a comprehensive Pan-African Resource Repurposing Strategy for Brain Health – one that identifies underutilised resources and fosters sustainable, affordable and locally driven solutions,” the report notes.

Expertise in managing infectious diseases such as HIV can be harnessed to help with the early detection of dementia, for example.

Community health workers can be trained to identify early signs of the disease, primary healthcare facilities can serve as hubs for cognitive screening, education and management, and dementia care can be included in non-communicable disease (NCD) services.

Breaking down silos

“A well-integrated research and data ecosystem is essential for identifying high-risk populations and implementing targeted dementia prevention and early intervention strategies,” the report notes.

However, Africa’s research and information systems are fragmented, with “weak data-sharing platforms, limited connectivity between research hubs, and a lack of standardised mechanisms for harmonisation and reporting”. 

It proposes establishing “a Pan-African network of research centres” to drive a harmonised, transdisciplinary approach to data generation and utilisation. 

It also advocates for “strengthening cross-sector collaboration through partnerships between health systems, governments, researchers and nongovernmental organisations” and global partnerships.

Tech-enabled systems

“Digital health solutions offer accessible, scalable and cost-effective alternatives to traditional healthcare approaches,” and Africa’s mobile technology “revolution” means it is well placed to adopt these, the report notes.

New digital biomarkers enable early and accurate detection, monitoring and treatment of brain disorders – including data from speech patterns and typing.

This “allows for passive and remote monitoring of cognitive changes”, which facilitates the use of AI.

Digital technologies can also play a critical role in “identifying and mitigating modifiable risk factors associated with cognitive decline”, including “sleep patterns, physical activity, social engagement and mental health indicators (such as depression)”.

But AI-driven solutions are often developed on and for high-income populations, which means Africa needs “a pan-African strategy for AI and machine learning solutions in brain health”.

Strengthening research funding

“To attract investment from both public and private sectors, brain health leaders must present a compelling economic and social case,” the report notes. 

It proposes that brain health is integrated into existing healthcare priorities such as maternal and child health, NCDs and social determinants of health. 

Way forward

As Africa transitions to a society with smaller families, there is the prospect of greater economic wealth as the working-age population becomes proportionally larger than the non-working-age population – and this offers a chance to implement measures to prepare for an older population, the paper argues.

To effectively implement the priority areas outlined in the 6 × 5 Plan, DAC launched a pan-African task force on brain health in March 2025. 

The task force’s organising committee, which provides strategic oversight, is composed of DAC, the World Health Organization (WHO), the World Economic Forum (WEF), the World Bank, Alzheimer’s Disease International (ADI) and the African Union. 

DAC leads the secretariat, which coordinates operational support and communication. Six thematic chairs – covering research, nonprofit, industry, policy, economics and systems thinking – shape strategy and liaise with working group leads. 

Six working groups, led by operational leads from the five geopolitical zones, focus on executing the priorities of the 6 × 5 plan, ensuring regionally relevant and inclusive solutions across Africa.

“Unlike research efforts that focus on therapeutic interventions, DAC’s model emphasises health system transformation, from earlier detection and evidence-based care pathways to strengthening workforce training and improving global data sharing,” according to a media release from the Geneva-based collaboration.

Image Credits: Kizito Makoye Shigela/HPW, UCLA .

European Union Environment Commissioner Jessika Roswall and Danish Environment Minister Magnus Heunicke address reporters at the United Nations in Geneva as time runs out to strike a global plastics treaty.

GENEVA – The European Union said Tuesday it is ready to make a deal on a global plastics treaty but will not accept an agreement “at any cost,” leaving the door open to rejecting a weak outcome as negotiators enter the final 72 hours of talks with core provisions still deadlocked.

“The EU is here to deal, but not at any cost,” Environment Commissioner Jessika Roswall told journalists when asked about reports the bloc was prepared to walk away if production limits were excluded from the final agreement. “If there is no agreement that is good enough, these are negotiations. That’s always an opportunity for everyone in negotiations.”

The commissioner’s carefully worded intervention came as high-level delegations arrived at the United Nations hoping to break a week-long impasse over production caps, health provisions, toxic chemical restrictions, financing, and definitions of key terms, including “plastic pollution” itself.

Countries also remain divided on the treaty’s fundamental scope: whether the agreement should address the full lifecycle of plastics — from feedstock extraction to disposal — or focus only on waste management and recycling.

The EU and an alliance of over 100 states are pushing for hard caps on plastic production, but face stiff opposition from plastic-producing nations. The “like-minded nations” group led by Saudi Arabia, Russia, Iran and their allies—flanked by the United States and India—have shown no signs of softening their total opposition to production limits in the treaty.

“Everyone will need to compromise,” Roswall said, calling on all 184 nations present to speed up progress towards a deal. “We have a global responsibility to fix this. No country can do this on its own.”

Danish Environment Minister Magnus Heunicke, speaking alongside Roswall, characterised the negotiations as “very difficult,” warning that tensions and “drama” would escalate in the coming days as Thursday’s deadline looms over the talks.

“There’s going to be a whole lot more drama in the days to come,” Heunicke said. “If you are looking for drama, I’d say stay here, because more drama is going to happen. But our goal is that this drama should end up in a deal.”

Both officials declined to specify the EU’s red lines, citing the sensitivity of ongoing negotiations. However, Heunicke emphasised production as a key concern, calling plastic pollution “one of the greatest environmental challenges” globally.

“We know it harms our health, it harms our oceans, it harms our future,” Heunicke said. “At the same time, we also know that plastic production is increasing at an exponential rate. That’s why the EU is here … to secure a legally binding international agreement on how plastic is produced, consumed and disposed of.”

The consensus-based format of the negotiations, which requires unanimous agreement for the treaty to be accepted, has been roundly criticised by nations and observer delegations for allowing nations seeking to weaken or remove articles on health, toxic chemicals and production limits to maintain their positions with little incentive to compromise.

Juan Carlos Monterrey, Panama’s negotiator, told a panel on Monday that the like-minded nations had “not moved an inch” since talks began last week.

Ninety-nine per cent of plastics are made from oil, gas and coal, generating a market projected to reach $1 trillion annually in the next decade. Major petrochemical states see booming plastic production as a hedge against declining demand for fossil fuels in traditional energy markets.

Behind closed doors

Press conference held on Tuesday by the Scientists’ Coalition for an Effective Plastics Treaty.

Progress in the negotiations has been difficult to gauge for civil society observers and media alike. Crucial debates over the treaty’s scope, definitions of key terms like “plastics” and “plastic pollution,” limits on toxic chemicals used in plastics and production caps have all occurred behind closed doors.

Neither INC representatives nor the UN Environment Programme, which oversees the negotiations, have held a press conference since Saturday. That briefing offered few details, with INC chair Luis Vayas Valdivieso deflecting questions about specific treaty articles and which issues were proving the most difficult to bridge between nations.

Negotiators are working from a text with nearly 1,500 items of disagreement on which no progress has been made since Saturday, leaving nations 13 pages further from agreement than after the last round of talks in Busan, South Korea, in December.

Melissa Blue Sky, a senior attorney at the Centre for International Environmental Law, noted that the brackets don’t indicate the weight of support: while some clauses have backing from 100 countries, others may have only one supporter, yet all appear equal.

“The draft text is misleading because it presents all options as having the same weight, when in fact, some text additions have the support of over a hundred countries and some with only one,” Blue Sky said. “The INC cannot continue with the status quo and expect the negotiations to result in a final treaty.”

As nations race to find a compromise, experts from the Scientists’ Coalition for an Effective Plastics Treaty — after a brief venue shuffle due to meeting room overbooking — held a press conference stressing the health and environmental consequences if negotiations fall short.

“The science is really undeniable that we need plastic production reduction and we need [it] on global levels and at national levels to be really, really ambitious if we’re going to see any benefits,” said Natalia Grilli, an environmental scientist from the University of Tasmania. “For us, the science is clear. We’re not negotiators … so it’s not that we have red lines. We’re responding to the science.”

It remains unclear when the next treaty text will be released. The clearest picture of progress from recent negotiating flurries will likely emerge at Wednesday’s expected plenary session, though none has been formally scheduled.

Sources close to national delegations told Health Policy Watch they expect negotiations to extend deep into Thursday night and likely into Friday morning, an all-too-typical endgame for UN environmental negotiations.

“If it was only up to the EU, then we all know how high ambitions would be,” Heunicke said. “It is not, however, up to the EU.”

“If we all stick to our red lines, that deal is impossible,” the Danish environment chief added. “We will be worse off if we don’t succeed in making a deal. That’s not me saying a deal at any price, but a deal that is legally binding and has strong text and lays the ground for our work in the years ahead.”

GENEVA — Fossil fuel and petrochemical lobbyists have descended on UN plastics treaty negotiations in record numbers, as delegates from over 180 countries attempt to forge a global agreement to stem the tsunami of plastic pollution drowning the planet.

According to a new analysis by the Centre for International Environmental Law (CIEL), at least 234 lobbyists representing fossil fuel and chemical interests are attending the talks in Geneva, exceeding the combined delegations of the European Union and its 27 member states. 

Industry representation, which has steadily increased since talks began in 2022, now outnumbers expert scientists by three to one and Indigenous representatives by four to one. Nineteen of the lobbyists are registered as members of national delegations, including those of Egypt, Kazakhstan, China, Iran, Chile and the Dominican Republic.

“We have decades of evidence showing the fossil fuel and chemical industries’ playbook: deny, distract, derail,” said Ximena Banegas, CIEL’s lead campaigner on plastics and petrochemicals. “After obstructing climate negotiations for years, why would anyone expect them to act in good faith at the plastics treaty talks?”

CIEL cautioned that its estimate likely underrepresents the scale of lobbying, as some participants may not openly declare industry affiliations. The figure also omits representatives from adjacent sectors such as consumer goods and waste management, as well as informal advisers and lobbyists active in the inter-sessional rounds held since the collapse of talks in Busan, South Korea, last December.

“Involving the very corporations that profit from harm in shaping the path forward guarantees one thing: a treaty that protects their bottom line—not the public or the planet,” Bengas added.

UN Environment Programme Executive Director Inger Andersen addresses the opening plenary of negotiations in Geneva, Switzerland.

Over 99 per cent of plastics are derived from oil, gas or coal, creating a near-total overlap between fossil fuel and petrochemical interests. Many of the same companies have also sought to influence international climate negotiations, with fossil fuel lobbyists numbering 1,773 at COP29 in Dubai. 

“The treaty meant to stop plastic pollution is being shaped by those who profit from it,” said Dylan Kava, communications lead for the Pacific Islands Climate Action Network. “You cannot solve a crisis by putting its primary cause at the decision-making table. And you cannot speak of justice while sidelining the very communities fighting for survival.”

Industry-aligned countries, including China, Russia, Iran and the US are pushing for a treaty centred on downstream measures such as recycling, circular economy principles and waste management. Yet less than 10 per cent of plastic waste is recycled globally, despite decades of investment and research.

“It is now clear that the world cannot recycle its way out of the plastic pollution crisis,” a landmark study in The Lancet, published on the opening day of talks, concluded.

More than 100 countries, including EU member states and the Alliance of Small Island States, support a legally binding cap on plastic production, reiterated at the UN Oceans Conference in Nice, France, in June. Many others have backed proposals to phase out harmful polymers and chemicals of concern.

“We need to get a solution to this problem. Everybody wants it. I’ve yet to meet somebody who is in favour of plastic pollution,” Inger Andersen, executive director of the UN Environment Programme, told delegates. “Plastic pollution is already in nature, in our oceans and even in our bodies. If we continue on this trajectory, the world will drown in plastic, with grave consequences for planetary, economic and human health.”

“But this does not have to be our future,” Andersen said. “It is in your hands to ensure it does not happen. It is in your hands to protect us all, the environment and future generations.”

Intimidation by design

Talks continue at the Palais des Nations in Geneva as delegates from over 180 countries attempt to finalise a binding global agreement to curb plastic pollution.

The petrochemical industry’s tactics extend beyond influencing treaty language or embedding lobbyists within national delegations.

Ahead of the Geneva talks, The Guardian reported on a coordinated campaign of intimidation, surveillance and obstruction by fossil fuel and petrochemical representatives targeting scientists and negotiators.

Bethanie Carney Almroth, a professor of ecotoxicology at the University of Gothenburg and member of the Scientists’ Coalition, described repeated instances of harassment, verbal abuse and invasive monitoring by industry figures at negotiations, unofficial side events, academic conferences and emails.

“I have a privacy screen protector on my phone because they walk behind us and try to film what’s on our screens—what notes we’re taking or who we’re messaging,” Almroth told The Guardian. “I would never open my laptop in a public space without knowing who is behind me. It’s a high-vigilance, high-stress environment.”

The UN Environment Programme, which oversees the treaty process, has faced repeated criticism since negotiations began in 2022 over a perceived lack of safeguards against conflicts of interest. Similar allegations have dogged the United Nations Framework Convention on Climate Change (UNFCCC) in its handling of industry access to climate COPs, including last year’s COP30 in Baku. 

Support for strengthening the plastics treaty has grown steadily. Chart showsthe  number of nations backing WWF “must-haves,” which include global chemical bans, circular economy design requirements, financing, and guarantees to strengthen the treaty over time.

Greenpeace wrote to UNEP Executive Director Inger Andersen on Tuesday, warning that the “once in a lifetime” opportunity to address the plastics crisis risks being “fatally undermined” by unchecked industry interference.

“There is clear precedent for action to prevent conflict of interest,” the letter stated, citing the World Health Organization’s Framework Convention on Tobacco Control, which explicitly excludes tobacco industry representatives. “The companies profiting from plastic pollution must not be allowed to shape the treaty meant to stop it.”

Ahead of the talks, a University of Cambridge study coined the opposition to the treaty the “petrochemical historical bloc,” finding the bloc is “driving up plastics production, externalizing the costs of pollution, distorting scientific knowledge and lobbying to derail negotiations.”

“There’s a fundamental, irreconcilable conflict of interest between the companies producing plastics and all of us who want to end plastic pollution,” said Rachel Radvany, head environmental health campaigner for CIEL.

“We have been calling on Member States since the beginning, and even more as we’ve seen the negotiations progress, to put strong conflict of interest policies in the treaty text and in the future COPs,” Radvany added. “This is not normal, and this should not be the way it works.” 

Organised resistance

President Donald Trump’s return to office has been hailed as “an answered prayer” by the US plastics industry.

Organised resistance to a global plastics treaty centred on production caps has been led by Saudi Arabia, supported by Russia, Iran and China since talks began in 2022. Under President Donald Trump, the United States has now joined their ranks.

This week, Reuters reported that the US delegation circulated letters urging countries to oppose treaty provisions targeting plastic production limits and chemical restrictions. These were described as “red lines” for the administration.

“We will not support impractical global approaches such as plastic production targets or bans and restrictions on plastic additives or plastic products – that will increase the costs of all plastic products that are used throughout our daily lives,” the memo, seen by Reuters, reads.

Limiting hazardous chemicals is a core demand from public health advocates. More than 16,000 chemicals are used in plastics, over 4,200 of which are considered “highly hazardous” to human health. An additional 5,000 compounds are classified as “unknowns,” with no public data on their safety or long-term impacts.

The Health Crisis That Could Make or Break the UN Plastics Treaty

While the previous US administration opposed production limits throughout much of the negotiation process, President Joe Biden made a notable policy reversal ahead of the last round of talks, dropping objections to caps on plastic production. 

However, following Trump’s victory ahead of the December negotiations in South Korea, the Biden administration largely abstained from participation in that final round in Busan. Industry representatives hailed Trump’s return to office as “an answered prayer” for US plastic producers.

The new administration first signalled its opposition at an informal meeting in Nairobi, where it stated: “We support an agreement that focuses on efforts that will lead to reducing plastic pollution, not on stopping the use of plastics.”

Speaking to E&E News as talks resumed in Geneva, a spokesperson said the US approach would reflect “the Trump administration’s America First foreign policy,” adding: “The United States supports an agreement that respects national sovereignty and focuses on reducing plastic pollution without imposing onerous restrictions on producers that would hinder US companies.”

With consensus required for the treaty to advance, the firm alignment of the US with the petrochemical bloc has dealt a heavy blow to hopes of a strong agreement.

“They’re basically going full MAGA,” a source close to the talks told The Guardian. “They’re clearly coordinating with Saudi Arabia, Russia and others, because they’re using the same language.”

Production surge as industry seeks a lifeline

Expanded government investment in petrochemical sector production capacity, particularly in the Middle East, China and the United States, has “flown under the radar of the public,” a 2023 study by the University of Lund concluded.

The diplomatic resistance of petrostates to a strong treaty has unfolded in parallel with a rapid expansion of their global petrochemical infrastructure.

The global petrochemical industry was valued at $638 billion in 2023 and is expected to reach $838bn by 2030. The broader oil and gas sector, responsible for supplying the fossil fuel feedstocks for plastic production, is valued at $6.9 trillion, making it one of the largest industries in the world.

Global plastic output has grown more than 250-fold since 1950, from less than two million tonnes to 475 million tonnes in 2022. At current rates, plastic production is projected to triple by 2060, according to the OECD. 

Today, plastics production already releases more than 2 gigatons of CO₂ and other greenhouse gases annually. If the plastics industry were a country, it would be the world’s fifth-largest greenhouse gas emitter, behind only China, the US, India and Russia.

If plastics production triples as expected, it would account for roughly a quarter of the remaining carbon budget that scientists say must not be exceeded to avoid breaking the Paris Agreement target of 1.5C. 

Despite engaging with the UN Plastics treaty process, major producers plan continued expansion of petrochemical and plastics production, according to University of Lund Research.

“We know for sure that all main producers are increasing capacity: US, China, South Africa, Brazil, Iran, Saudi Arabia,” Joan Marc Simon said, founder of Zero Waste Europe, told DW. “The only place where capacity is going down slightly is in the European Union. The rest of the world is increasing.”

This shift is not incidental, but central to the industry’s long-term survival. As demand for fossil fuels in the energy sector declines amid a shift to renewables, oil and gas companies have increasingly turned to plastics as a lifeline. Industry projections suggest that plastic production could double in the next 10 to 15 years, and triple by mid-century. 

Since the treaty process began in 2022, major producers—including Dow, ExxonMobil, BASF, Chevron Phillips, Shell, SABIC and Ineos—have added 1.4 million tonnes of new plastic production capacity. Saudi Aramco, the state-owned oil company, plans to channel about one-third of its oil production to plastics and petrochemicals by 2030. 

“The petrochemical industry needs plastic as a safe haven from carbon liabilities,” a 2021 report from the International Pollutants Elimination Network (IPEN) found. “Increasing plastic production offsets falling demand for its fossil fuels. Plastic waste generation is expected to rise sharply as a result.”

Follow our UN Plastics Treaty coverage: 

https://healthpolicy-watch.news/plastics-crisis-costs-trillions-kills-hundreds-of-thousands-each-year-lancet-finds/

Image Credits: UNEP, UNEP, White House , UNEP.

A trial participant is prepared for a blood test during a trial of new medicines for drug-resistant TB.

Close collaboration between researchers and community groups has been key to South Africa more than halving the incidence of tuberculosis (TB) in the past decade, according to researchers and community activists.

Women researchers and advocates have been at the heart of the country’s fight against TB, and several South African scientists have also led global TB research breakthroughs, according to presenters at a webinar on Thursday, co-hosted by Global Health Strategies, Bhekisisa and Health Policy Watch.

But the sudden and substantial loss of donor funding this year may translate into 580,000 fewer people being tested for TB and 35,000 fewer getting TB treatment this year, according to researchers writing in the International Journal of TB and Lung Disease (ITLD).

The country lost $34 million overnight from the US Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief (PEPFAR) – $12 million for TB prevention, $5 million for screening, $10 for testing and $7 million for treatment.

This cut could have a dire impact on the figt against tuberculosis, which kills over 56,000 South Africans daily.

Interdisciplinary collaboration

 

 

Top: (L-R) Valeria Mizrahi, Thuli Khanyile (moderator), Anura David. (2nd row) Monica Longwe, Sibongile Tshabalala, Mia Malan (moderator), Lee Fairlie and Nandipha Titana.

Watch the full webinar >>

Professor Valerie Mizrahi, a leading TB researcher for over three decades, says that South Africans have made “massive contributions” to the global TB fight because of “a high degree of integration, collaboration and coordination”.

“We are a community of people who work together to tackle the disease in an interdisciplinary way,” Mizrahi told the webinar.

Basic scientists, clinical researchers and public health specialists collaborate with civil society advocates, community engagement experts, and government “with a unified vision of what we’re trying to achieve,” said Mizhari, who recently retired as director of the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town. 

“At the core of this integrated enterprise are women.”

“South Africa has a fantastic TB programme,”  Prof Lee Fairlie told the webinar, detailing how advances in TB diagnosis and treatment, including new and shorter regimens for multi-drug resistant TB, had been pioneered in the country.

New TB vaccines are in late-phase trials, while researcher Anura David, from Wits University’s Diagnostic Innovation Hub, is currently working on a TB self-test based on an oral swab to deliver faster, easier results.

But the funding cuts have “severely affected” TB research, said Fairlie, who needs to “work hand-in-glove with communities” when recruiting people for these TB studies.

Resources for data collection and monitoring and evaluation have been hard hit.

A pharmacist holds two sets of pills in her hand, showing the difference between those taken under the newer regiment for drug-resistant TB versus the old treatment at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa.

Certain programmes – such as those aimed at men who have sex with men and transgender people – have disappeared completely, said Fairlie, director at maternal and child health at the Reproductive Health Institute (RHI) at Wits University in Johannesburg.

Some 15,000 frontline staff and 9,000 technical staff have lost their jobs, according to the TB Accountability Consortium in a recent presentation to the South African Parliament.

“Many people have lost funding. Many people have had to be retrenched. And of course, this takes us a steps back from potential breakthroughs around optimal treatment for both HIV and TB,” said Fairlie.

She added that there is a real risk that “people are falling out of care, not having access to treatment, which if you’re living with HIV, obviously increases your risks of becoming diseased with TB”. 

Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC), said a recent survey of around 8,000 patients at 300 clinics found TB testing has dropped and that waiting times have increased since posts for health workers and testing facilities have been eliminated. Only half of those surveyed 

The TAC’s education campaigns on TB and HIV have also been affected.

Appeal to the government

A little TB patient at Brooklyn Chest Hospital in Cape Town, South Africa.

Before the funding cuts, the South African government launched its “End TB” campaign, which aims to test five million people for the bacteria by the end of next year. 

But the TB Accountability Consortium points out that there is only funding for three million TB tests, and describes the health budget as “chronically underfunded”.

Half the world’s funding for TB research and development comes from only two sources: the Gates Foundation and the US National Institutes for Health (NIH), which has changed its funding priorities since the Trump administration assumed power, said Mizhari.

“This is forcing us to look inward as African countries and to actually take our seat at the table of responsibility for looking after this field,” said Mizhari.

She warned that the South African TB sector is going to be “severely tested in the near term”, and the only way in it can unlock the necessary funds from donors and funders is to “make a very, very powerful case for the value proposition for tuberculosis, and I think that we’ve all got to think very deeply about what that is going to entail in a resource limited setting where there are so many other competing priorities.”

Time to prioritise

“We cannot sit back and just accept that this is the way things are going to be,” Mizhari urged. “We need to look at what our priorities are. We need to find much better ways to share information, to avoid duplication, and to double down on what it is that we need to do. There is no public health problem that is more severe and serious than TB.”

Tshabalala urged the private sector to invest in TB, particularly urging large employers to step in.

Meanwhile, Fairlie pointed out that researchers are “entirely dependent on donor funding”, and called for “increased collaboration across the spectrum” to ensure that “important work remains funded”.

This article is based on a webinar co-sponsored by Health Policy Watch, Global Health Strategies and Bhekisisa. Watch the full webinar.

Image Credits: TB Alliance, USAID, Southern Africa/Flickr.

WHO Director General Dr Tedros Adhanom Ghebreyesus at Thursday’s press briefing in Geneva.

WHO has confirmed reports of 99 people who died of malnutrition-related deaths in 2025, up until the end of July, including 64 adults and 35 children, most of the latter  under the age of five, said WHO Director General Dr Tedros Adhanom Ghebreyesus on Thursday. 

According to the Hamas-controlled Gaza Health Ministry, the number of malnutrition deaths this year has twice as high, exceeding 200 deaths as of the first week of August.  

Speaking at a press briefing for the Geneva UN Press Corps, Tedros added that while more supplies are now flowing into Gaza, the food as well as medical aid now entering, “is only a fraction of what is needed.”

Tedros also called for the release of the 50 Israeli hostages held by Hamas in Gaza, 22 of which are believed to be alive – “and for their humane treatment and access to medical care and food.”

In a special UN Security Council session on Wednesday, Israel, the United States and hostage family members denounced the Hamas starvation of their loved ones. The session followed last week’s release by Hamas of video footage of two gaunt hostages, Rom Braslavsky and Evyatar David – with David tallying the meager rations he had eaten over the past week.

Hamas released a video Aug. 1 showing 24-year-old Israeli hostage Evyatar David, visibly emaciated, tallying his food rations, and digging what he called his own grave inside a tunnel in Gaza.

“In July, nearly 12 000 children under five years were identified as suffering from acute malnutrition, the highest monthly figure ever recorded,” Tedros said at the briefing.

“Diseases continue to spread, fuelled by overcrowding and deteriorating water, sanitation and hygiene conditions, severely affecting the youngest,” he added, noting the growing concerns with two outbreaks in particular, of meningitis and Guillain-Barré syndrome, the latter a condition in which the immune system attacks the nerves, and which may be triggered by an acute bacterial or viral infection.

“As of the 31st of July, a total of 418 suspected cases of meningitis and 64 cases of Guillain-Barré syndrome have been reported, with a noticeable increase in July,” he noted.

Iman, six months old, is screened for malnutrition at an UNRWA medical point in Gaza city in July 2025.

Dying of hunger and in the search for food

WHO officials said that the data on malnutrition deaths, last updated on 29 July, was compiled from direct reports by Gaza hospitals, and then evaluated by WHO on the basis of factors such as body mass index, before being added to the count.  

“Meanwhile, people are dying not only from hunger and disease, but also in the desperate search for food,” Tedros said. Since 27 May, more than 1600 people have been killed and nearly 12,000 injured while trying to collect food from distribution sites, he said. 

The large number of deaths have been blamed not only on Israeli army open-fire orders, but also on the paucity of food distribution points – including four points controlled by the controversial Humanitarian Foundation – following a prolonged food blockade in March and April.  

Gaza Palestinians tote away food from a UN distribution site in late June – desperate crowds have had to run a gauntlet of Israeli army fire in their quests to reach only a few food distribution points.

The flow of supplies began to increase in May-July, and even more over the past week, with more UN as well as commercial trucks permitted to enter, along with airdrops of food packages into Gaza by Jordan, the United Arab Emirates and others. But as of July, the total volume of supplies entering the enclave only amounted to about  60% of the caloric needs of Gaza’s population of two million, according to data compiled by The Guardian from Israeli military reports of food truck deliveries. 

Meanwhile, more and more supplies are being looted en route to distribution points by desperate mobs of hungry people. Social media footage has also shown both armed gangs and Hamas gunmen, riding atop convoys of the flatbed trucks laden with sacks of flour and other essentials.

With increased desperation, has come  “a breakdown of law and order, creating dangerous conditions under which humanitarian operations are forced to be conducted,” said Tedros.

“The overall volume of nutrition supplies entering Gaza remains completely insufficient to prevent a further deterioration in the nutritional situation,” said Rick Peeperkorn, head of WHO’s office in the Occupied Palestinian Territories, speaking by video relay from Jerusalem. “The market needs to be flooded. There should also be a little to the diet, dietary diversity,” he added, noting a “complete breakdown in access to any diverse, nutritious foods.”

WHO is also supporting Gaza’s sole malnutrition treatment center in Gaza, and there too, “supplies are very low.”

Fears of repeat attack by Israeli military on WHO warehouse 

Despite the Israeli military attack on WHO’s main medical supply warehouse and staff residence in late July, WHO has als0 continued shipments and deliveries of medical supplies to Gaza’s hospitals, Tedros said.  The WHO warehouse and nearby staff residence were attacked by Israeli military drones and artillery shells on 21 July. Four male staff members were also detained in the incident, with one still in Israeli custody. See related story. 

WHO Denounces Israeli Attacks on its Gaza Warehouse and Staff Residence in Latest Military Offensive

Despite the damage, WHO has delivered a total of 68 trucks of essential medicines, blood, trauma and surgery supplies since late June, Tedros said.

But the WHO Director General expressed concerns about the risks posed by ongoing Israeli military operations in the vicinity of the warehouse, located in the coastal area of Deir Al Balah, which has only recently begun to see widespread military operations.

“Our premises need ongoing protection,” Tedros said. “Displacement orders issued….yesterday are risking the safety of our warehouse, which is 500 metres from the evacuation zone,” he noted. 

Medical evacuations – more host countries needed 

Sick and injured Palestinians leave Gaza for an airlift to the UAE via Israel’s Ramon airfield in July 2024 – so far 7,522 patients have been moved, but twice that number remain trapped in Gaza in urgent need of specialized medical care abroad.

More than 14,800 patients in Gaza are also in urgent need of medical evacuation for specialised medical care,  Tedros stressed, appealing to host countries to accept more evacuees. 

Since the conflict began in October 2023, WHO has helped to evacuate 7522 patients from Gaza, Tedros added, including 15 critically ill children moved to Jordan on Wednesday. 

“We urge more countries to step forward to accept patients and for medical evacuations to be expedited through all possible routes,” Tedros said.

“The ongoing blockages must be stopped and greater volumes of aid need to come in to rebuild critical reserves,” he added, calling for a “scaled-up, sustained and unimpeded flow of humanitarian aid, including food and health aid, in line with international humanitarian law, via all possible routes.

“We also call for humanitarian corridors to evacuate those in need of urgent medical care outside Gaza.  We call for the protection of health workers, patients and all civilians. 

“We call for the release of all remaining hostages, and for their humane treatment and access to medical care and food.

“We call for the immediate and unconditional release of our [WHO] colleague who has been detained since the 21st of July. And most of all, we call for a ceasefire, and a lasting peace.”

Correction – A statement that data on Hamas reported malnutrition deaths in Gaza was more than five times higher than WHO figures was based on incorrect interpretation of the data.  Hamas reported an excess of 200 deaths by the first week of August, roughly twice that of WHO figures. 

Image Credits: UNRWA, E. Fletcher/Health Policy Watch, Hostages and Missing Families Forum , X/Channel 4 News , WHO.

The consumption of sugary drinks is driving NCDs including obesity and diabetes.

The language on health taxes has been further weakened in the latest draft of the political declaration on non-communicable diseases (NCDs), due to be adopted by the UN High-Level Meeting (HLM) in September  – and it’s a done deal unless UN member states raise specific ojections.

Member states have until noon Eastern Time on Thursday to “break the silence” on the draft political declaration, which involves reopening negotiations on issues that are considered “red lines” by member states.

Reference to a tax on sugar-sweetened beverages (SSB) has been removed altogether, while languge on alcohol policy has been watered down, the NCD Alliance told a meeting of allies on Wednesday.

The target of getting member states to “implement health taxes” on unhealthy products such as tobacco, alcohol and SSBs in the zero draft, has been replaced by asking them to “consider” measures such as “policies and fiscal measures for prevention and health promotion”, said Marijke Kremin, the NCD Alliance’s advocacy and policy manager in New York.

In addition, the language on the environmental determinants of NCDs (primarily air pollution) has also been weakened, said Kremin.

The zero draft’s target of 80% of primary health facilities having access to essential medicines for NCDs and mental health by 2030 has been reduced to 60%.

Some targets survive

However, tobacco control, hypertension and improving mental health care remain the cornerstones of proposed action to contain NCDs. 

The zero draft’s 2030 global targets of 150 million fewer people using tobacco, 150 million more people controlling their hypertension and 150 million more people having access to mental health care, have survived the negotiations.

Kremin said that the coming weeks ahead of the HLM on 25 September could be “very fast moving and potentially somewhat volatile” as “breaking the silence is becoming more and more commonplace”.

“We see a handful of countries breaking silence over a handful of routine items,” she explained.

“In the instances where silence is broken, that usually means the [country] delegation will work things out bilaterally with the co-facilitators. Any changes to the text means that an updated document is re-shared and placed back under silence.” 

Once the co-facilitators decide that they have worked enough with member states in good faith, they will submit it to the President of the General Assembly. 

Despite the UN member states’ reluctance to encourage health taxes – largely attributed to power lobbying by tobacco, alcohol and junk food companies – there is growing recognition that such taxes can help address the crisis of funding for global health.

On Tuesday, WHO Director General Dr Tedros Adhanom Ghebreyusus told African leaders in Ghana that a 50% increase on taxes on harmful products like tobacco, alcohol, and sugary drinks could “generate an additional $3.7 trillion globally within five years and save millions of lives”. 

Image Credits: Adam Jones / Flickr, Heala_SA/Twitter.

Summit host, Ghana’s President John Mahama.

“Africa needs health without aid,” former Nigerian president Olusegun Obasanjo told the continental health sovereignty summit in Accra, Ghana, on Tuesday.

He appealed to leaders to establish a health fund under the auspices of the African Development Bank, funded initially by an airline tax on tourists flying to African countries – an idea that has been floating around the African Union for the past few years.

Obasanjo addressed the opening of the summit, convened by Ghana’s President John Mahama in response to the 40% reduction in development aid in the past two years – the steepest cuts taking place over the past eight months since US President Donald Trump assumed office.

Obasanjo, one of the sponsors of the summit, urged leaders not to “wring their hands” but “find solutions” to the funding crisis.

Olusegun Obasanjo, former president of Nigeria, was one of the drivers of the summit.

Mahama said he was building on the momentum from other countries, including Rwandan President Paul Kagame, to mobilise more funds for health during a time of “overlapping and intensifying global crisis” – caused by wars, pandemics, climate shocks, economic volatility and widening inequalities.

“This is not merely a funding gap. It is a crisis of imagination, a vacuum of solidarity and a deep failure of shared responsibility,” said Mahama.

Presidential task team

He announced the formation of the Presidential High Level Task Force on Global Health Governance, a platform for African leaders to engage with global and continental partners and to redesign the health governance system.

“The world has changed, but global health governance has not kept pace with the changing world. At this moment, we’re called to redesign the architecture that has, for far too long, excluded Africa’s voices, excluded Africa’s needs and innovations.”

He acknowledged that the abrupt loss of US funding had brought the country’s community-based health delivery model “to its knees”.

In response to the cuts, Ghana has uncapped its national health insurance scheme financing and launched the Ghana Medical Trust Fund, to mobilise capital to tackle chronic diseases.

Mahama also announced that a health tool called SUSTAIN is being rolled out to assist governments to identify all their domestic and international sources of health funding, identify gaps and plan for sustainability.

SUSTAIN (an acronym for Scaling Up Sovereign Transitions and Institutional Networks), will also assist countries to mobilise funding from the private sector, philanthropic partners and the Africa diaspora, said Mahama.

The World Health Organization (WHO) has also offered technical assistance to countries to mobilise more resources.

Opportunity for self-reliance

Dr Tedros addresses the summit

WHO Director General Dr Tedros Adhanom Ghebreyesus told the summit that the “sudden and steep cuts to aid” is “causing the most severe disruptions to health systems since the peak of the COVID-19 pandemic”.

Tedros added that, according to WHO’s latest analysis, “health aid is projected to decline by up to 40% this year compared to just two years ago. This is not a gradual shift – it is a cliff edge. Lifesaving medicines are sitting in warehouses, health workers are losing jobs, clinics are closing, and millions are missing care.”

However, within the crisis lies “an opportunity to shake off the yoke of aid dependency, and embrace a new era of sovereignty, self-reliance, and solidarity”, Tedros said.

“Africa does not need charity. Africa needs fair terms.”

He urged countries to develop health benefit packages for essential services, and raise money from health taxes on tobacco, alcohol and sugary drinks. A 50% increase on taxes on harmful products like tobacco, alcohol, and sugary drinks could “generate an additional $3.7 trillion globally within five years and save millions of lives”, said Tedros.

African countries can also save through pooled procurement for medicines, investment in domestic manufacturing and better budget execution using digital public financial management systems.

But Tedros warned that up to 13% of health budgets in low- and middle-income countries go unspent due to weak public financial systems.

Tedros warned that debt service burdens are crowding out social investments, while the illicit flow of money is weakening economies.

“In 2023, Africa received $74 billion in aid – but lost $90 billion to illicit financial flows and $55 billion to corporate tax exemptions,” said Tedros. “Africa lost much more than it gained. This is unacceptable.”

Mahama urged countries to reject the “outdated notion” that health drains their economies, instead insure that finance ministers frame health as a capital investment and a “productivity multiplier and not a consumption expense”.

“The WHO has shown that for every $1 invested in health resilience yields up to $4 in returns. This return is even greater in Africa, where youthful populations represent latent economic dynamism.”

Women learn how to access information about contraception on their smartphones during a session on family planning in Makassar, Indonesia.

The Gates Foundation is investing $2.5 billion in research and development (R&D) on women’s health over the next five years, focusing primarily on maternal care and sexual health.

This comes amid a massive defunding of global health led by the United States, which is threatening progress in key areas such as maternal health, sexual and reproductive health and HIV.

The foundation has selected five priority areas: obstetric care and maternal immunisation; making pregnancy and delivery safer; maternal health and nutrition; gynaecological and menstrual health; and contraceptive innovation and sexually transmitted infections (STIs).

These were selected “based on a combination of data and evidence about where innovation can save and improve the most lives, direct insights from women in low- and middle-income countries about their needs and preferences, and the persistently high rates of misdiagnosis caused by gaps in medical knowledge and training,” according to the foundation in a media release.

Dr Anita Zaidi, president of the Gates Foundation’s Gender Equality Division, added: “For too long, women have suffered from health conditions that are misunderstood, misdiagnosed, or ignored. We want this investment to spark a new era of women-centred innovation – one where women’s lives, bodies, and voices are prioritised in health R&D.”

Dr Bosede Afolabi, professor of obstetrics and gynaecology at the College of Medicine, University of Lagos in Nigeria, said: “We see the consequences of underinvestment in women’s health innovation every day when women suffer needlessly, and sometimes lose their lives, because of the gaps in how we understand and treat conditions that uniquely affect them.”

Under-researched areas

A 2021 McKinsey analysis found that just 1% of healthcare research and innovation is invested in female-specific conditions beyond oncology.

Meanwhile, the US National Institutes of Health (NIH) allocated 13.5% for research related to women’s health in 2005, whereas this year, that figure has declined to around 10%, according to Guttmacher.

The foundation’s research will include HIV pre-exposure prophylaxis (PrEP), a field where several breakthroughs have occurred recently – only to have these research wins undermined by defunding by the United States government.

It will also examine “deeply under-researched” critical issues such as “preeclampsia, gestational diabetes, heavy menstrual bleeding, endometriosis, and menopause”.

“Investing in women’s health has a lasting impact across generations. It leads to healthier families, stronger economies, and a more just world,” said Bill Gates, chair of the Gates Foundation. 

“Yet women’s health continues to be ignored, underfunded, and sidelined. Too many women still die from preventable causes or live in poor health. That must change.”

US defunding women’s health services

A young woman gets assistance at the UNFPA office in Afghanistan

The foundation’s investment comes as the US under the Trump administration has sharply reduced its spending on global health, threatening to reverse progress in several fields, including maternal and child health and HIV.

For example, this year, the US cut all funds to UNFPA, the United Nations sexual and reproductive health agency. 

Aside from around $180 million in annual funding, the cut affects $377 million in aid for “maternal health care, protection from violence, rape treatment and other life-saving care in over 25 crisis-stricken countries and territories, including Afghanistan, Chad, the Democratic Republic of the Congo, Gaza, Haiti, Mali, Sudan, Syria and Ukraine”, according to UNFPA.

It has also dismantled the US Agency for International Development (USAID), and slashed the budgets of the US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Centers for Disease Control and Prevention (CDC)’s Maternal and Child Health Branch and Global Health Center, cutting millions of dollars in aid to low and middle-income countries for health programmes affecting women.

As a result of these cuts, Guttmacher estimates that “47.6 million women and couples will be denied modern contraceptives, resulting in 17.1 million unintended pregnancies and 34,000 preventable pregnancy-related deaths”.

US gynaecologists decline federal funds

The Trump administration is also defunding domestic groups supporting US women’s sexual health, including Planned Parenthood, which primarily provides contraceptive services (only 5% of its activity involves providing abortions).

This is despite the fact that maternal deaths in the US are “more than double, sometimes triple, the rate for most other high-income countries”, according to a 2024 Commonwealth Fund Study.

Nearly two-thirds of US maternal deaths occur during the postpartum period, up to 42 days following birth, when US women are least likely to get follow-up care in comparison to other high-income countries. The US was also the only country in the study without mandated maternity leave, and where all pregnancy costs were not covered by medical insurance.

Meanwhile, the maternal mortality rate for Black US women in 2022 was more than double that of the national average  – 49 deaths per 100,000 in comparison to the average of 22 deaths per 100,000.

However, programmes targeting Black women have largely been dismantled by the Trump administration, which has outlawed any spending on “diversity, equity and inclusion” (DEI).

Last week, the American College of Obstetricians and Gynecologists (ACOG) announced that it would no longer accept federal funds as the Trump administration’s policies “prevent it from providing evidence-based guidance”, Axios reported.

“Recent changes in federal funding laws and regulations significantly impact ACOG’s program goals, policy positions, and ability to provide timely and evidence-based guidance and recommendations for care,” ACOG told members in an email quoted by Axios.

ACOG represents around 60,000 board-certified obstetrician-gynaecologists and its vision is “an equitable world in which exceptional and respectful obstetric and gynaecologic care is accessible to all”.

The Trump cuts primarily affect the delivery of services – particularly for sexual and reproductive health and HIV – while the Gates Foundation’s investment is in R&D.

However, the foundation hopes that, by addressing gaps in women’s health, their investment will “unlock broader social and economic gains”. 

“Research shows that every $1 invested in women’s health yields $3 in economic growth, and closing the gender health gap could boost the global economy by $1 trillion per year by 2040,” it noted.

Image Credits: ©Gates Foundation/ Prashant Panjiar, UNFPA Afghanistan, Commonwealth Fund.

Zahi Azrak Hospital in Aleppo, Syria, in July 2021. Much of Syria’s healthcare infrastructure was damaged in the country’s civil war.

Syria is looking to rebuild its healthcare system after a 14-year long civil war that left at least 300,000 dead and 70% of its population dependent on humanitarian aid.

But the new government faces a major challenge in ensuring the safety of minority groups, along with access to healthcare and humanitarian aid.

The primarily Druze region of Sweida in southern Syria saw a fresh wave of violence in July, displacing 175,000 people. More than 1,400 people were killed, including in reported extra-judicial executions by Bedouin and government troops sent to secure the area, according to multiple media and eyewitness reports as well as the UK-based Syrian Observatory for Human Rights.

UN Syria Envoy Geir Pedersen has expressed serious concerns over “credible reports” of summary executions, arbitrary killings, and abductions of Druze women in Sweida city, following the entry of government security forces in July.

Sweida, which is 91% Druze, has remained under siege with water, food and fuel being in short supply and only one ICRC convoy reaching the area on 29 July – just before fresh clashes erupted again over the weekend between Druze militias and Syrian security forces.

Huge gap in governance, Syrian Health Minister admits  

Lines for rationed bread in Sweida, the primarily Druze minority area of southern Syria, which remains under siege by Syrian government forces after deadly violence in late July.

The new government of Syrian President Ahmed Al-Shaara, which took charge earlier this year, says stabilizing its health system is a priority, but lack of finance and the fact that most of the country’s health workers have left the country to flee the brutal conflict, are its two biggest challenges.

“We still have a huge gap in governance. We have more than one system. There are discrepancies and differences between different regions and geopolitical areas in Syria,” said Syrian Health Minister Dr Musaab Nazzal al-Ali. “Also, in financing we have very limited resources,” he said, speaking through a translator.

Al-Ali, who also addressed the situation in Sweida and listed out government efforts, was speaking at an online discussion organized by the Center for Strategic and International Studies (CSIS), a think-tank based in Washington, DC.

Dr Musaab Nazzal al-Ali, Syria’s health minister, speaking at an online discussion organized by the Center for Strategic and International Studies (CSIS).

There’s no part of the health system that hasn’t been spared in terms of the effects of the conflict, said Dr Diana Rayes, former chair of the Syria Public Health Network, which advocates for the health issues of Syrians.

“Thinking about people and how they have endured such suffering over time, there has been a significant mental health impact. And I think the prevalence is about half of Syrians, whether diagnosed or not, have symptoms related to a mental health condition,” Rayes said.

Nearly 40% of the country’s healthcare infrastructure was destroyed in the conflict, according to government estimates. What makes the task harder for the Syrian government is that it is trying to raise funding to rebuild in a landscape of multiple humanitarian crisis and donor fatigue.

Finance, health workers needed 

A young man moves through the rubble of what were once homes in Ma’arrat An Nu’man, Idleb province, Syria

During Syria’s civil war, the ruling regime led by President Bashar al-Assad targeted health facilities and  healthcare workers, according to various stakeholders. Anywhere between 50% – 70% of the country’s healthcare workers have left the country.

“Most of them were politically persecuted, especially in the early years of the Syrian situation, and also their ability to integrate in other contexts is much more likely. So, there’s a significant displacement of the health workforce,” Rayes said.

To add to the woes, medical equipment in Syria is outdated. “The most recent equipment in Syria in the public sector was purchased in 2011,” al-Ali said.

The Assad regime had faced international sanctions which was lifted only a few months back. The country is short of dialysis and MRI machines, as well as basics like ambulances but the government has been unable to do much as it lacks the money to do so.

The UN estimates that this year alone, the funding required for Syria is $3.2 billion but the country has received only 12% of that aid.

Liberia is an example, Iraq a cautionary tale

Dr Diana Rayes, Atlantic Council Fellow and former chair of the Syria Public Health Network.

Syria’s health system is currently in a transitional phase, seeking to move from one that responded to emergencies to a more sustainable healthcare system coordinated by the health ministry.

“In addition to meeting immediate health needs in the current moment, they also have to lay the groundwork for a more permanent, more sustainable health system, and that’s no easy feat,” Rayes said.

She said Syria can learn from Liberia which, post-conflict, rebuilt its health system by focussing on primary healthcare, training the health force, and working with donors.

Syria’s neighbour, Iraq is a cautionary tale which had a similar healthcare system to Syria before the conflict, she warned.

“Despite a lot of international support that came in to support the Iraqi health system in rebuilding, it’s never really fully recovered, and access in rural areas remains very limited, and there’s an over-reliance on the private sector,” Rayes said.

Relying on humanitarian aid alone in the long run will be unsustainable, experts agreed.

Dr Bachir Tajaldin, Türkiye Country Director of the Syrian American Medical Society Foundation (SAMS), said that while the support of the international community is important in health system strengthening “that will not continue forever”.

Building bridges – Syrian government’s attempt

Dr Bachir Tajaldin, Türkiye Country Director, Syrian American Medical Society Foundation (SAMS).

The conflict in Syria has also broken trust between the government and the population, as well as between the Syrian government and other countries.

After being polio-free for decades, Syria experienced an outbreak in October 2013 after the disruption in the routine immunization programme.  Many believed this disruption to be deliberate retaliation by the Assad regime against citizens who rejected his rule, Tajaldin explained.

Al-Ali said that his government is working on rebuilding relationships with other countries, and has already signed agreements with some governments to rebuild health facilities.

But the dismantling of USAID has disrupted aid flowing into Syria as US was the leading donor globally for humanitarian response.

“We’ve also seen other countries scale back some of some of their support as well, due to donor fatigue, but also this changing landscape,” Rayes said, adding that Syrians in the diaspora are a potential source of support, and especially technical support, apart from regional players like Qatar.

Security situation remains ‘volatile’

Deadly violence rocked Sweida in July, when Bedouin militias attacked the primarily Druze minority area of southern Syria.

But stabilizing Syria’s healthcare system also requires inter-religious and ethnic violence to abate. Minority groups like the Druze and Alawites are at heightened risk of persecution because of their perceived past support for the Assad regime, and their religious and ethnic differences from the current Sunni Arab government, led by Ahmed al-Sharaa.

In March, more than 970 civilians, mostly from the minority Alawite community, were killed following attacks by government security forces on community strongholds in Latakia and Targus, along the Mediterranean coast. Former President Assad, whose government was overthrown in December 2024, was an Alawite.

In July, Bedouin militia invaded Sweida, a governorate in southern Syria covering some 5,000km with a population of about 375,000 people, 91% of which are Druze. Extra-judicial killings, rapes and random executions have been reported.

Government troops sent to quell the violence reportedly entered the fray themselves. The government forces finally withdrew after an internationally-brokered deal but Sweida has remained under siege with little fuel or food reaching major population centers, including Sweida city, home to some 75,000 people.

Renewed clashes over the weekend

Sweida governorate, a primarily Druze area, in southeastern Syria, adjacent to Dar’a province, where the Syrian civil war began in 2011, and to the west of that, the Quneitra, border of the [unmarked] 1967 armistice line between Syria and the Israeli-occupied Golan Heights.

Last weekend, renewed clashes broke out again, killing at least four people including both Druze militia members and Syrian security forces.

Currently, the situation in Sweida is volatile with humanitarian access constrained, and ambulances and aid workers obstructed or becoming targets in the violence, said Edem Wosornu, of the UN Office for the Coordination of Humanitarian Affairs (OCHA).  Drinking water and food is scarce, according to reports on the ground.

 

Stocking up on drinking water in Sweida, where water as well as food is in short supply.

In a recent statement,  UN Envoy Pedersen expressed concern about “reports of abductions of Druze women after the entry of security forces into particular areas, and reports of women, children and men who are missing.”

While Druze were the initial victims of killings, summary executions and kidnappings carried out by “members of security forces and individuals affiliated with the authorities,” other “armed elements from the area, including Druze and Bedouins” have also perpetrated violent attacks, Pedersen noted.

“Sweida is besieged and it is forbidden to bring in aid,” said one former Sweida Druze resident, speaking to Health Policy Watch from the United Arab Emirates. “They are bringing in some materials but it is forbidden to [bring in] fuel such as fuel oil and gasoline.”

He blamed government forces, more than Bedouin militia, for pursuing a campaign against the Druze, noting that some three dozen villages and towns in the region are either surrounded or occupied by government troops, triggering the mass displacement of residents along with the reports of killings, kidnappings, and property destruction.

“This issue is not a war between the Druze and Bedouins. This is a systematic war by the interim authority… this is not a national army but an extremist army from ISIS and Al-Nusra, not only against the Druze but against Christian and even moderate Sunni Muslims.”

When questioned about the humanitarian situation in Sweida, al-Ali said that the government was trying its best to get aid in despite the security challenges. “It is a long-running problem that has developed between some parties. The state and the security forces have tried to intervene to resolve the problem. The situation has developed so dramatically that even other countries have intervened,” he said.

Image Credits: UNOCHA/Ali Haj Suleiman, UN Syria, Flickr, France 24, UNOCHA/Ali Haj Suleiman, European Union Agency for Asylum..

Plastics are a “grave, growing and under-recognised danger” to people and the planet, causing “disease and death” from infancy to old age, a landmark review has found.

The Lancet Plastics Countdown, published as diplomats from around the world arrived in Geneva on Monday for the overtime round of talks on a global plastics treaty, estimates the cost of just three plastic chemicals at $1.5 trillion across 38 countries, representing one-third of the world’s population.

“It is clear we are in a plastics crisis,” the review found. “Plastics are not as inexpensive as they appear and are responsible for massive hidden economic costs borne by governments and societies. These impacts fall disproportionately upon low-income and at-risk populations.”

Plastics pollute human health through an array of pathways, including direct exposure to waste fills or chemical plants, environmental contamination, absorption through food packaging, microplastics, air and soil pollution, and burning of feedstock fossil fuels. 

The health consequences are equally varied, from birth defects and microplastic poisoning in the womb. to asthma, various cancers, heart attacks, hormone disruption, and developmental problems. 

Plastics affect human health across their production cycle from extracting the fossil fuels that make up 98% of plastics, to use, and eventual disposal, the report found. 

One chemical alone, BPA, was associated with 5.4 million cases of ischaemic heart disease and 346,000 cases of stroke in 2015, killing 237,000 and 194,000 people, respectively. BPA is one of 16,000 chemicals present in plastics.

PM2.5 emissions from plastic production were responsible for an estimated 158,000 premature deaths globally and health-related economic losses of more than $200 billion, the report found.

Yet limited global data means these vast sums are equally vast underestimates. The $1.5 trillion price tag is for just 38 nations. Surging plastic production is multiplying future risks from waste, and there are still vast knowledge gaps in the health effects of plastic chemicals, so researchers warn that this number could grow exponentially.

“What is also abundantly clear, and that’s coming from the science as well, is that without intervention, the problem will not go away. It will escalate,” said Martin Wagner, co-author of the Lancet report. “Global plastic production is bound to triple by 2060, escalating not only the environmental pollution aspect, but also the associated health consequences.”

What’s in our plastic? 

Map developed by the Lancet showing all the pathways, exposures and health consequences downstream from the full life-cycle of plastics.

In the majority of cases, scientists simply don’t know what the chemicals in plastic are, or what they might do to health. 

Complete safety information is missing for more than two-thirds of the chemicals used in plastics, according to the Lancet. Where data exists, it’s often incomplete, with three-quarters of plastic chemicals never properly assessed for human health impacts.

When authorities restrict or ban chemicals, manufacturers often replace them with structurally similar substitutes that carry the “same or other unknown hazards,” according to the Plastics Health Map, an open-source database mapping research on plastic chemical exposures.

The pace of scientific evaluation adds another layer of delay. Studies on the health impacts of substitute chemicals typically commence years after their introduction to the market, creating a perpetual knowledge gap.

As plastic chemicals proliferate faster than research can evaluate them, both regulatory systems and scientific understanding struggle to keep pace with determining their health effects.

Just six per cent of all plastic chemicals are regulated under multilateral environmental agreements. Around 1000 additional compounds are regulated at the national level by a small number states.

“Despite their large production volumes and widespread human exposure,” the report states, hazard information remains missing for thousands of chemicals in everyday use.

Of the plastic chemicals that have been studied, the picture is alarming. Approximately 4,200 substances have been found to be highly hazardous due to their toxic effects, persistence, and bioaccumulation.

Almost 1,500 are carcinogenic, mutagenic, or toxic to reproduction, and more than 1,700 are toxic to specific organs like the liver.

Scientists say we have enough evidence to act.

“Some people will tell you, do you have enough scientific evidence proving that the plastics are affecting human health?” said Dr. Maria Neira from the World Health Organization. 

“People, do you have enough evidence demonstrating that having microplastics in our placenta is a good thing for human health? Start by the end, are you happy with having microplastics everywhere in our body?”

Living in sacrifice zones

Entrance to a chemical plant, 40 minute drive from Barrow’s home.

For Jo Banner, co-founder of the Descendants Project, these statistics represent daily reality. Her town of St James’ Parish in Louisiana’s industrial corridor – known as Cancer Alley – bears the brunt of petrochemical production.

The elevated risks of physical health issues, including cancer, heart disease, respiratory illness, strokes, and reproductive health problems, earned her town and surrounding region a grim moniker: “sacrifice zone”.

“Sacrifice zones” originally described communities around nuclear weapon testing sites, but has expanded to encompass areas where residents are exposed to disproportionately high levels of industrial pollution. 

Banner’s community is among more than 1,000 toxic hot spots across the United States where an estimated 250,000 people face elevated cancer risks from industrial air pollution. 

“Science is one thing, but science doesn’t work when we have a population that is sacrificed for the economy,” Banner told at a Geneva press conference Monday. “My ancestors were brought to the United States to work the plantations and were sacrificed. We, as descendants of those enslaved Africans, are also facing that same type of sacrifice.”

The UN Special Rapporteur on Human Rights and the Environment identified millions of people at risk worldwide from similar industrial pollution to Cancer Alley, causing nine million premature deaths annually – twice as many as COVID-19 caused in its first 18 months. The Rapporteur blamed businesses for being willing to cut corners – and lose lives – to protect or expand their bottom line.

“Our areas are described as cancer alley, but it could also be called asthma alley, anxiety alley, heart attack alley,” Banner said. “The petrochemical companies and plastic makers only works when our communities are sacrificed.”

Thousands of miles away in Kenya, John Chweya experiences a different part of the same crisis. As president of the Kenya National Waste Pickers Welfare Association, he represents workers who live and work in landfills where plastic waste burns continuously.

An estimated 20 million people worldwide work as waste pickers, collecting about 60% of all plastic recycled globally. Those living directly in landfills face constant exposure to toxic fumes from burning chemicals, many of which remain unidentified.

“It’s always like 24/7 breathing in plastic. Even when it rains, you will see smoke,” Chweya said, adding that community members frequently developed health conditions they were unable to identify or seek treatment for.

“About 22 years ago, I was compelled to live in a landfill in Kenya called Kisumu, a very small city. And during that time, I encountered people that I would call family,” Chweya said. “Today, as I sit here, most of these people I call family are no longer alive.”

Cap or no cap 

The UN Plastics Treaty will be hammered out – hopefully – over the following two weeks. The goal of the talks is to establish a legally binding mechanism to protect people and the planet from the ever-growing tsunami of plastic waste suffocating oceans, forests, mountains, air, animals, microorganisms and cities.

More than 100 UN member states have supported setting legally binding targets to cap plastic production as talks begin Tuesday. Many more have voiced support for phasing out harmful plastic production and chemicals of concern from plastic production. 

The Lancet report identifies this surge in production as the “first and most fundamental” driver of the plastics crisis. This is also the defining fight of the upcoming negotiations as major petrochemical powers like Saudi Arabia, the United States, Russia and China push back on production limits while they seek to expand petrochemical manufacturing. 

Global output has grown more than 250-fold from less than two million tonnes in 1950 to 475 million tonnes in 2022. This surge is driven partly by fossil fuel companies pivoting toward plastics as demand for energy declines. The Saudi Arabian Oil Company plans to channel about one-third of its oil production to plastics and petrochemicals by 2030. 

Plastic production releases more than two gigatons of CO2 and other greenhouse gases every year. If the plastics industry were a country, it would be the fifth-largest annual greenhouse gas emitter in the world, behind Russia at 2.7 gigatons, and roughly double the next four nations of Brazil, Japan, Iran and Indonesia. 

While plastics have revolutionised fields from medicine to aerospace, 35-40% of production takes the form of single-use packaging, bottles, bags, and other disposable items, principally related to the food industry. 

Plastic-producing nations argue that the focus should be on recycling technologies and circular economies for plastics. But unlike other materials such as glass, paper, aluminium, or steel, the technology still does not exist to efficiently recycle chemically complex plastics.

“Despite decades of effort, less than 10% of plastics are recycled, and thus 90% are either burned, landfilled, or accumulate in the environment,” the report states. “It is now clear that the world cannot recycle its way out of the plastic pollution crisis.”

Life or death

A man floats along the Yamuna River in Delhi, India, collecting plastic bags to sell for recycling. 

The treaty requires consensus among all participating nations, but given the hard opposition from major petrochemical-producing countries, progress may require moving forward without holdouts. Donald Trump’s US and Saudi Arabia are unlikely to agree to production caps, while China, the world’s largest plastic producer, is likely to follow suit. 

“If the consensus required going for the minimum, the lowest denominator, that’s not a good consensus,” said Neira. “So be very ambitious, because it’s about the health of the people here.”

For Banner and Chweya, the question remains whether health arguments, which have failed over decades to drive decisive action at climate, biodiversity, and other UN environmental negotiations, will finally move the needle.

“I represent the ones collecting from the streets, the ones collecting from households and those living and working at landfills,” Chweya said. “I would say, for us, it’s a matter of life and death.”

Image Credits: Muhamad Numan, Chad Davis, Koshy Koshy.