The opportunity to limit warming to 1.5ºC with no or limited overshoot “has been lost”, UNEP warns for the first time, urging action to “minimise overshoot and return to 1.5ºC” by the end of the century.

The window to hold global warming below 1.5ºC has closed, and greenhouse gas emissions must nearly halve within a decade to keep the chance of limiting peak warming to 1.8C within reach, the UN Environment Programme (UNEP) declared on Wednesday.

In its annual Emissions Gap Report, which tracks the gap between where countries’ pledges put global emissions and the levels needed to stay below certain warming thresholds, UNEP for the first time dropped the premise that staying below 1.5ºC of warming was possible if deep and rapid emissions cuts took place.

With fossil fuel emissions and infrastructure both still expanding as the US exits the Paris Agreement, and the 67 new climate pledges submitted over the past year having a “near-zero impact” on expected warming in the face of the nearly 6% annual cuts required, the agency has flipped its framing to attaining the “lowest possible” overshoot.

“The chance of holding global warming to below 1.5ºC with no or limited overshoot is gone,” UNEP chief Inger Andersen said. “We climate procrastinated, and accordingly, we are now saying that this window has closed.” 

“Nations must understand that the point of return begins now. Not later – now,” she added.


The report finds that cuts of 18% by 2030, 45% by 2035, and 69% by 2040 – all from 2025 levels – and the removal of some 320 billion tonnes of CO2 from the atmosphere by 2100 are required to limit peak warming to 1.7-1.8ºC around 2050, before returning to 1.5ºC by the end of the century.

In their current state, fully delivered national climate plans (NDCs) – the emissions targets each country must update every five years – submitted by nations under the Paris Agreement would cut emissions just 5-8% by 2030 and 11-15% by 2035.

Under current policies, warming is tracking towards 2.8ºC, UNEP said. This emissions trajectory leaves the world with a 6% chance to hold warming below 2ºC this century and a one-in-four chance of exceeding 3ºC.

"The world can no longer avoid overshooting the 1.5º limit. And the consequences are already devastating," UN Secretary-General António Guterres said in his final remarks on UNEP's flagship report before his term ends in December. "Deadly floods. Brutal heatwaves. Raging wildfires. Lost lives. Crippled economies.”

"Those least responsible are suffering first and worst," Guterres added. "The emissions gap is now a leadership gap. And the world is running out of time and excuses to close it."

Emissions outlook worsens as US exits Paris

Contributions to the increase in GHG emissions (excluding LULUCF) in 2025 of the six largest emitters, the other G20 members, the rest of the world, and international transport.

Projected warming under the full delivery of NDCs scenario is up 0.2-0.3ºC from last year's report, to 2.6-2.7ºC. The scenario assuming the full delivery of net-zero pledges also increased to 2.1ºC, up from 1.9ºC.

Both rises are driven largely by a wholesale deletion of US commitments to climate action under Trump, who has described climate change as "the greatest con job ever perpetrated on the world". 

The US climate plan and Washington's former net-zero target were both struck from the calculations, accounting for about half of the rise under the NDC scenario, with revised historical emissions data making up the rest.

"We completely scrapped the NDC emissions scenario projections and assumed that the US will follow the current policy projections under the current administration's policies," Takeshi Kuramochi of the University of Tokyo, a lead author of the report, told reporters.

Projections of global warming under the pledge-based scenarios assessed in the report.

The US State Department, noting that its country’s exit from the UN climate convention will take formal effect in February 2027, inserted a disclaimer – as it did last year – that the US "does not support the Emissions Gap Report, does not endorse or agree with its analysis or conclusions, and has not provided comments to this report."

The US also posted the largest emissions increase of any country in 2025, adding 133 million tonnes of CO2 equivalent as electricity demand, driven in part by mass data centre expansion to fuel the AI boom, rose and coal power rebounded, with the Trump administration using emergency orders to delay coal plant closures.

"The climate impacts will not shield anyone," Andersen said when asked for her message to Washington. "We are seeing and will continue to see impacts on every nation on the planet, including the US."

Türkiye, host of next month's COP31 summit in Antalya, recorded the second-largest increase at 24.4 million tonnes, followed by Iran (18.9 million) and Indonesia (17.4 million). China's emissions rose by 17.2 million tonnes. International shipping and aviation together added 44.9 million tonnes, more than any country except the US.

Every five years of delay adds 0.1ºC to peak warming

Overall, global emissions held roughly flat in 2025, as lower wildfire and land-use emissions masked the continued growth in fossil fuel CO2.

"This is similar to the level in 2024, which is a welcome divergence from a growth trend of past decades," said Anne Olhoff, the report's chief scientific editor. "However, it's too soon to conclude anything about plateauing or peaking of global emissions."

While a plateau may appear positive news, UNEP data show it is far from enough. Five years of emissions at current levels adds around 200 billion tonnes of CO2 to the atmosphere, locking in an increase in peak warming of about 0.1ºC.

"Continued insufficient emission reductions over the next decades could make warming of 2ºC inevitable, putting the Paris Agreement at risk of failure," the report warns.

This rate of increase is visible in the literature. When the IPCC last assessed emissions pathways in 2022, assuming deep cuts would begin in 2020, the lowest peak still within reach was about 1.6ºC. Those cuts never came. With action now assumed to start in 2025, the best achievable peak has risen to around 1.7ºC.

"This is a historic failure of political leadership. The science has been clear for decades, but governments have chosen delay over action," said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa. "The consequences will be measured in lives lost, not just degrees of warming."

'On track' to weak targets

GHG emissions in 2035 resulting from the full implementation of the new NDCs of G20 members compared with current policies projections, absolute (MtCO2e/yr) and percentage (%) change.

Only six G20 members – China, India, Indonesia, Russia, South Africa and Türkiye – are "on track" to meet their 2030 emissions targets. Together, G20 members account for 76% of global emissions.

That may seem an odd list – because it is. In fact, as nations set their own pledges, in turn reflecting varying ambition to curb emissions, the list of "on track" nations is better read, in several cases, as a list of those with low-ambition targets.

Russia and Türkiye's projected emissions already sit more than 20% below their 2030 emissions targets, providing headroom for major emissions increases from their current baseline without technically breaching their commitments. Both have "historically always set NDC target emission levels that are considerably above the current policy scenario projections," the report notes.

India – the world's third-largest emitter – is also likely to meet its target. This is explained by the unusual formulation of India's NDC, which sets an emissions-intensity target tied to its GDP, meaning an expanding economy also allows for expanding emissions. 

India's pledge allows its emissions to rise about 1.25 billion tonnes between 2030 and 2035, though at 3.1 tonnes per person, its per capita emissions remain under half the world average.

The nine G20 members judged off track include the UK, Japan, Canada, Australia, and South Korea. Mexico – previously on track for its 2030 goals – fell off the list after strengthening its emissions targets.

The European Union, committed to the largest absolute cut of any G20 member between 2030 and 2035, at about 630 million tonnes, may narrowly miss its 2030 goal, according to two of the three studies the report reviewed.

Still building, still burning


Clean energy investment is set to reach $2.2 trillion in 2026, almost double investments in fossil fuels, the report says, citing the International Energy Agency. But as renewables gain an ever-growing foothold on traditional energy markets, governments continue to lock in new fossil fuel infrastructure and keep drilling.

Governments plan to produce 120% more fossil fuels in 2030 than a 1.5C pathway allows, up from 110% two years ago, according to the 2025 Production Gap Report, which measures the gap between governments' planned fossil fuel production and levels consistent with the Paris Agreement's warming limits. Some 96% of upstream oil and gas companies are still developing new reserves, according to campaign group Urgewald.

Fossil fuel subsidies climbed from $660 billion in 2018 to $920 billion in 2024, after hitting a record during the 2021-22 energy crisis, and could rise again as governments shield consumers from the ongoing energy shocks of the US-Israeli war on Iran, the report said.

Counting the unpriced costs of the pollution and climate damage fossil fuels cause, the International Monetary Fund puts implicit subsidies at a further $6.7 trillion in 2024, three-quarters of it from air pollution and climate change.


As governments subsidise oil and gas to stave off inflation, fossil fuel giants are reaping massive windfalls. The five largest Western oil majors earned $48 billion in the second quarter, or $535 million a day, according to Global Witness analysis.

Saudi Aramco reported $104.7 billion in adjusted net income for 2025 and paid out $85.5 billion to shareholders, more than three times the $26 billion in international public finance that reached developing countries for climate adaptation in 2023.

The world's 65 largest banks, meanwhile, continued to provide nearly $1 trillion in fossil fuel financing in 2025.

"It is time for major fossil fuel producers such as the US and Saudi Arabia (which produce 20-25% of fossil fuels globally) to stop playing politics and face the scientific reality," said Bill Hare, chief executive of Climate Analytics. "Right now, they are looking at the fire, denying it exists and pouring more petrol on it."

"Do the governments and fossil fuel producers of the world really want seven metres of sea level rise and the demise of many entire island countries as their legacy?"

Image Credits: Marcin Jozwiak.

A health worker in protective gear responds to Ebola.

Nigeria’s lone Ebola patient was only diagnosed almost two weeks after showing symptoms – and is reported to have travelled to the capital, Abuja, from Uganda via Addis Ababa in Ethiopia.

She entered Nigeria on 3 October, started showing symptoms on 7 October and was admitted to hospital two days later – but was only diagnosed on Tuesday (20 October), according to a statement from the World Health Organization’s (WHO) Africa region.

The patient is said to be the wife of a Ugandan diplomat. Uganda was declared Ebola-free in August after treating 20 people who had contracted the Bundibugyo virus imported from the Democratic Republic of Congo (DRC)

“Investigations are ongoing to establish the likely source of her infection and reconstruct her full travel and exposure history,” said the WHO, adding that Nigeria’s Health Ministry had identified 44 contacts.

“[These contacts] are being monitored as efforts are intensified to find other people who may have been exposed. Infection prevention and control measures are being ramped up in the private health facility where the patient sought care,” the WHO added.

Kenya’s nine cases were all quarantined contacts of the first case, who died after travelling across the DRC, according to the country’s Health Ministry. Three are health workers, one is a hospital cleaner, and four are relatives of the patient. 

The Kenyan government says it has traced 128 of the 130 identified contacts (98.5%)  of the deceased, and they are all in quarantine.

The case fatality rate in the DRC is over 48%, with most cases in Ituri province. On Sunday, authorities in North Kivu introduced a week-long ban on people travelling from Ituri in a bid to slow transmission.

North Kivu’s authorities have also suspended large sporting activities, concerts, parades and nightclubs. They have limited passenger numbers for vehicles and introduced mandatory vehicle disinfection, hand washing and temperature screening at checkpoints.

In light of the Nigeria case, the WHO Africa region has urged countries to “maintain strong disease surveillance and rapid alert investigation, ensure laboratories can safely test suspected cases, keep rapid response and clinical teams ready for immediate activation, [and] reinforce infection prevention and control in both public and private health facilities.”

African health ministers will meet next week to discuss Ebola as Nigeria reported its first case, Kenya’s outbreak has infected nine people, and the DRC reported 9,455 cases.

The meeting was announced on Wednesday by the Africa Centre for Disease Control and Prevention (CDC), which described Ebola as an “escalating threat to health security across the continent”.

Image Credits: Belen B Massieu/Shutterstock.com, Africa CDC .

Who will steer the World Health Organization through its next chapter? Explore Health Policy Watch’s daily series examining the platforms, records, and institutional hurdles facing each contender for WHO Director-General, continuing today with Dr Hanan H. Balkhy. Access all candidate profiles on our dedicated election site.

Pledging "A WHO the world can count on," Dr Hanan H. Balkhy bases her platform on scientific independence, rapid emergency response, and fiscal accountability.
Pledging “A WHO the world can count on,” Balkhy bases her platform on scientific independence, rapid emergency response, and fiscal accountability.

Saudi Arabia’s nomination of Dr Hanan H. Balkhy, an infectious disease epidemiologist and WHO regional director for the Eastern Mediterranean region, brings a senior regional executive into the candidate pool to succeed Dr Tedros Adhanom Ghebreyesus as Director-General. Drawing on a background combining frontline clinical care, scientific research, and multilateral governance, Balkhy positions her candidacy as a direct response to institutional distrust and member state demands for operational transparency and accountability.

A US-trained paediatrician and infectious disease specialist, she centres her campaign around the core pledge: “A WHO the world can count on.” Balkhy frames her background as a “hybrid” career: combining 20 years of domestic health system leadership in Saudi Arabia – including 15 years serving on WHO external expert committees – with over seven years inside WHO as Assistant Director-General and Regional Director – spanning headquarters in Geneva and regional leadership over the agency’s most complex emergency settings.

As a senior WHO executive, however, her central challenge will be overcoming the perception of being an institutional insider at a moment when many member states are calling for fundamental restructuring. To build a winning coalition, she must convincingly prove that an executive who rose through the agency’s own hierarchy can deliver genuine operational decentralisation and fiscal discipline while remaining a steadfast guardian of WHO’s normative core and independent technical authority.

Balkhy’s three-layered vision for WHO’s future

The Cairo EMRO headquarters, maintaining regional operations as Director Hanan Balkhy begins her campaign leave.
The Cairo EMRO headquarters where Balkhy serves as regional director (currently on campaign leave).

Balkhy structures her election platform around a three-part framework focused on restoring trust through scientific independence, accelerating impact through rapid emergency preparedness, and demonstrating fiscal value through quantifiable results:

  1. Scientific integrity and transparent governance: Balkhy frames institutional credibility as WHO’s foundational requirement, pledging to restore scientific authority, protect technical guidance from political interference, and strengthen internal reporting across all three organisational tiers. As evidence of her commitment to administrative accountability, she points to her operational track record in the Eastern Mediterranean, where she reduced the regional audit backlog by 50%.
  2. Emergency preparedness and regional sovereignty: Focusing on rapid crisis response, she advocates for an integrated One Health framework bridging human, animal, and environmental vectors, while positioning Small Island Developing States (SIDS) as the benchmark for equitable global health security. To build regional health sovereignty, she prioritises binding Pathogen Access and Benefit-Sharing (PABS) equity and promotes collaboration with regional bodies like Africa CDC and the African Medicines Agency to expand local biomanufacturing and regulatory infrastructure.
  3. Frontline delivery and climate resilience: Balkhy links organisational performance directly to quantifiable country-level health gains, establishing primary healthcare (PHC) as the leading operational vehicle for universal health coverage (UHC). Her agenda embeds climate resilience into primary care, prioritises the elimination of wild poliovirus and vaccine-preventable diseases, and advocates for mechanisms to ensure lower-income countries access new health technologies on equitable timelines.

Addressing global health architecture reform, Balkhy’s platform highlights the imperative of rebalancing operational power toward country and regional offices. Pointing to her track record as EMRO Regional Director – where over 70% of regional programme resources were allocated directly to country offices – she pledges to transition WHO from top-down directives toward a consultative, country-led model that moves resources directly to where health care is delivered.

Formative clinical training and two decades of prevention

Massachusetts General Hospital in Boston: Balkhy completed her paediatric residency here before spending two decades directing infection control in Saudi Arabia.
Massachusetts General Hospital in Boston where Balkhy completed her paediatric residency before spending two decades directing infection control in Saudi Arabia.

While born in Saudi Arabia, Balkhy spent her early childhood in the United States until the age of six when her family returned to the Kingdom. She later completed her undergraduate medical degree at King Abdulaziz University in Jeddah in 1991. She returned to the US for postgraduate clinical training, completing a paediatric residency at Massachusetts General Hospital in Boston (1993-1996), followed by a fellowship in paediatric infectious diseases at the Cleveland Clinic Foundation and Rainbow Babies & Children’s Hospital in Cleveland, Ohio (1996-1999).

Upon returning to Saudi Arabia, Balkhy spent two decades developing national infection prevention and research infrastructure. She served 10 years as hospital epidemiologist and 10 years as executive director of infection prevention and control at the Ministry of National Guard. In that capacity, she established and directed the infectious diseases research department at the King Abdullah International Medical Research Centre (KAIMRC) within King Saud bin Abdulaziz University for Health Sciences in Riyadh.

Under her direction, KAIMRC served as a regional reference centre for MERS-CoV, where she led Saudi Arabia’s first Phase I clinical vaccine trial for the virus and established cross-sectoral One Health research linkages. Meanwhile, she directed the Gulf Cooperation Council (GCC) Center for Infection Control and the WHO Collaborating Centre for IPC and Antimicrobial Resistance (AMR).

Executive trajectory in Geneva and regional leadership

Balkhy’s candidacy draws on executive experience in Geneva and regional emergency response across EMRO.
Balkhy’s candidacy draws on executive experience in Geneva and regional emergency response across EMRO.

Building on her national track record, Balkhy transitioned to international governance as WHO’s first Assistant Director-General for Antimicrobial Resistance (AMR) in Geneva (2019–2024). In this role, she steered global policy against drug resistance, launching the Quadripartite collaboration with the FAO, WOAH, and UNEP, raising $20 million for WHO’s AMR division, and establishing the AMR Multi-Partner Trust Fund. During the COVID-19 pandemic, her portfolio expanded as acting ADG for Access to Medicines and Health Products, while co-leading WHO’s role in the ACT-Accelerator Diagnostics Pillar.

Following her Geneva tenure, the WHO Executive Board appointed Balkhy as Regional Director for the Eastern Mediterranean in 2024. In this role – from which she is currently on formal leave to pursue her Director-General campaign – she oversees WHO health operations across 22 Member States and territories, serving a population of 750 million. Under her leadership, the region carried roughly one-third of WHO’s global graded-emergency burden, managing acute crisis responses across Yemen, Gaza, Sudan, and Lebanon, while raising over $1.6 billion in additional programme resources.

Demonstrating operational crisis management, she negotiated directly with senior representatives of the Taliban-led de facto administration in Afghanistan, utilizing community-level engagement in Kandahar to overcome vaccine hesitancy, protect essential health infrastructure, and secure access for polio vaccination teams. In the Occupied Palestinian Territory, following the re-emergence of polio in Gaza after 25 years, she coordinated a cross-agency emergency response and three vaccination cycles that reached more than 600,000 children to contain the outbreak.

“Across these roles, I have remained a physician, a scientist and a public health leader – committed to turning knowledge into action and keeping people at the centre of global health,” she noted in launching her campaign in August.

Expanding Saudi footprint and regional competition

The Riyadh skyline: Saudi Arabia’s expanding financial and diplomatic footprint provides a powerful institutional backdrop for Dr Hanan Balkhy’s candidacy.
The Riyadh skyline: Saudi Arabia’s expanding financial and diplomatic footprint provides a powerful institutional backdrop for Dr Hanan Balkhy’s candidacy.

Besides her clinical credentials and executive experience, Balkhy enters the race anchored by Saudi Arabia’s diplomatic and financial influence. The Kingdom’s total WHO contribution reached $100.12 million for 2024-2025 and stands at $81.72 million for 2026-2027. This places the country in the top 15 overall contributors worldwide (including both sovereign states and philanthropic organisations).

Her campaign could also benefit from a compelling institutional precedent: a Director-General has never been elected from the Eastern Mediterranean region. If member states prioritise geographic equity and regional rotation across WHO’s six regions, her standing as a prominent EMRO candidate and experienced regional executive gives her a distinct strategic advantage. Furthermore, as the first woman ever elected to lead WHO’s Eastern Mediterranean office, Balkhy’s candidacy aligns with global gender equity coalitions likely to push for the election of only the third female Director-General in the organisation’s history.

However, regional support across the Middle East and Islamic caucuses remains fragmented. The entry of Qatar’s former health minister, Dr Hanan Al Kuwari, introduces a direct rival within the Gulf Cooperation Council (GCC). Deep geopolitical fault lines across the region – most notably active hostilities involving Iran and Yemen – alongside the secret-ballot nature of WHO elections, make any unified regional bloc improbable, forcing Balkhy’s campaign to build a cross-regional coalition beyond the Middle East.

Navigating normative and climate challenges

Balkhy engages cross-regional delegations ahead of the election, seeking to become the Eastern Mediterranean’s first WHO director-general.
Balkhy engages cross-regional delegations ahead of the election, seeking to become the Eastern Mediterranean’s first WHO Director-General.

To build broad cross-regional consensus, her campaign emphasises her commitment to global health stewardship. This involves articulating how her drive to direct operational resources closer to country offices reflects administrative subsidiarity while fully reinforcing WHO’s centralised normative and standard-setting authority.

Having been nominated by a conservative member state and given current pressure on sexual and reproductive health and rights (SRHR), Balkhy will also have to convince liberal voting blocs that she will uphold WHO’s universal health mandates and preserve normative civil society partnerships without compromising technical integrity. Recent Executive Board proceedings highlighted these fault lines when delegates from conservative member states raised formal reservations regarding WHO’s official ties with reproductive health NGOs.

Finally, while her platform prioritises strengthening health system capacities to respond to climate-driven emergencies, her nomination by a major oil-exporting country reflects the broader institutional challenge of aligning fossil-fuel reliance with WHO’s normative commitments to climate action, clean air, and primary prevention.

A guardian of WHO’s normative core in an era of fragmentation?

Seeking to become the first WHO Director-General from the Eastern Mediterranean Region, Balkhy faces the challenge of uniting deeply divided member states behind her platform. To build a broad coalition, she launched an early diplomatic tour across the African Region (AFRO), South-East Asia (SEARO), and the Americas (PAHO) – although an earthquake in Panama briefly disrupted her travel, preventing her attendance at the candidate exchange at the World Health Summit in Berlin.

Ultimately, her candidacy represents a test of whether an institutional insider and physician-scientist can deliver structural decentralisation while remaining the steadfast guardian of WHO’s normative core. In an era marked by superpower exits, geopolitical rifts, severe fiscal austerity, and North-South divides, her pitch of “A WHO the world can count on” asks Member States to weigh her promise of operational subsidiarity against the imperative to preserve independent technical authority.

Note: Health Policy Watch reached out to Balkhy for comments, but has not received a response by the time of publication. Profiles will be updated as the campaign progresses, stay tuned on the microsite.

Image Credits: WHO, WHO/EMRO, Wikipedia/InvictaHOG, abul lais via Pexels.

Who will steer the World Health Organization through its next chapter? Explore Health Policy Watch’s daily series examining the platforms, records, and institutional hurdles facing each contender for WHO Director-General, starting today with Hanan Al Kuwari. Access all candidate profiles on our dedicated election site.

Serving as IGWG Vice-Chair alongside WHO leadership: Al Kuwari frames mandatory pathogen access and benefit-sharing as the essential equity commitment of pandemic reform.
As IGWG vice-chair, Al Kuwari framed mandatory pathogen access and benefit-sharing as the essential equity commitment of pandemic reform.

The State of Qatar has nominated former minister of public health Dr Hanan Mohamed Al Kuwari for Director-General of the World Health Organization (WHO). Entering a competitive contest alongside six other candidates as the WHO faces financial instability, workforce restructuring, and geopolitical fragmentation, her campaign positions her as a pragmatic, delivery-focused nominee.

During the first public candidate exchange at the World Health Summit in Berlin with four of the seven candidates, Al Kuwari articulated an operational roadmap centred on country-facing impact, emergency preparedness, and institutional reform. Central to her pitch is the assertion that WHO’s ultimate success must be measured in countries rather than in Geneva, arguing that member states are “not choosing an administrator; they are choosing a direction.”

Yet her candidacy raises questions for the member states: can a hospital and ministry executive safeguard WHO’s normative authority and scientific independence, and can middle-power mediation build lasting multilateral consensus amid escalating geopolitical superpower competition and persistent North-South divides?

Turning knowledge into country results: four pillars of change

Dr Hanan Al Kuwari discusses global health reform alongside fellow prospective WHO Director-General candidates at the World Health Summit in Berlin.
Dr Hanan Al Kuwari discusses global health reform alongside fellow prospective WHO Director-General candidates at the World Health Summit in Berlin.

In her election manifesto, “A healthier, fairer, better-prepared world”, Al Kuwari presents a four-pillar roadmap for the future of the WHO.

  1. Rebuilding institutional trust and independent authority: To address institutional distrust, Al Kuwari’s platform proposes strengthening WHO’s technical authority through open communication and objective governance. During the conversation in Berlin, she stated that “trust is built by process” and pledged to extend transparency standards to emergency and interim technical guidance while establishing independent oversight of WHO’s scientific advice with published reports.
  2. Ensuring political independence through stable financing: Confronting WHO’s ongoing fiscal crisis, her platform contends that an agency reliant on a narrow set of donors cannot maintain true political independence. She commits to working with member states to achieve the target of 50% assessed contributions (members’ fees) to the base budget by 2031 at the latest, while expanding flexible funding through the investment round and the WHO Foundation.
  3. Country-level delivery and primary healthcare execution: Emphasising that WHO’s value is ultimately demonstrated in country-level outcomes, her platform positions primary healthcare (PHC) as the core delivery vehicle for universal health coverage (UHC). She prioritises health workforce protection alongside targeted commitments to women’s, children’s, and adolescent health. Her agenda integrates non-communicable disease prevention, mental health, and polio eradication with emergency preparedness – operationalised through the amended International Health Regulations, One Health frameworks, and the WHO Pandemic Agreement.
  4. Preparing for future health threats: To address evolving health determinants, Al Kuwari proposes aligning global health research with equitable access, aiming to ensure lower-income countries receive vaccines, therapeutics, and diagnostics on the same timeline as high-income nations through regional manufacturing and streamlined WHO pre-qualification. Her platform also pledges to translate WHO’s digital health and artificial intelligence guidance into practical operational tools for member states, while framing climate change as a health emergency that requires WHO to supply the scientific evidence for climate negotiations.

To translate these four pillars into early operational reform, Al Kuwari pledged in Berlin to commission an independent functional review across WHO’s three organisational tiers within her first 100 days. Aiming to publish the findings within a year to eliminate bureaucratic overlap, she framed her benchmark for the end of a five-year mandate in 2032 not around Geneva administrative outputs, but around delivering tangible health results where people live.

From hospital management to national crisis response

Medical readiness for FIFA World Cup Qatar 2022: A cornerstone of Al Kuwari’s emergency portfolio and the operational basis for the WHO-Qatar Sport for Health framework.
Medical readiness for FIFA World Cup Qatar 2022: A cornerstone of Al Kuwari’s emergency portfolio and the operational basis for the WHO-Qatar “Sport for Health” framework.

Long before navigating Geneva’s diplomatic corridors, Al Kuwari built her executive credentials across nearly three decades of frontline institutional management and national crisis response in Doha.

Her early career encompassed freelance health reporting for Reuters and professional engagement with WHO, before she entered healthcare management in 1996 at Hamad Medical Corporation’s (HMC) Women’s Hospital. After earning a PhD in healthcare management from Brunel University in the United Kingdom in 2002, she was appointed managing director of HMC in 2007. Over a 17-year tenure, she expanded Qatar’s principal public healthcare provider into an integrated academic health system comprising 17 hospitals and specialised centres employing over 31,000 health workers.

Appointed Minister of Public Health in 2016, Al Kuwari steered Qatar’s health system through dual high-stakes emergencies. She chaired the national COVID-19 committee and directed emergency medical readiness for the FIFA World Cup in 2022. This three-year WHO-FIFA-Qatar “Sport for Health” partnership produced the global blueprint report, Changing the Game, which established international health security standards for mega-sporting events. Following an eight-year ministerial tenure, she was appointed advisor to the prime minister for public health affairs in late 2024.

Under her ministerial leadership, Qatar became the first country in the Eastern Mediterranean Region to achieve WHO “Healthy City” status across all of its municipalities, alongside two “Healthy University” certifications. Grounding her vision in Qatar’s National Health Strategy 2024-2030, she systematically embedded WHO normative standards nationally by establishing WHO Collaborating Centres spanning trauma, tobacco dependence, healthy ageing, zoonotic threats, and infectious disease research.

Global health governance and international leadership

The Assembly Hall at the Palais des Nations in Geneva during the 79th World Health Assembly.
The Assembly Hall at the Palais des Nations in Geneva during the 79th World Health Assembly.

Al Kuwari’s global health governance record spans senior leadership positions across WHO’s highest governing bodies and multilateral treaty negotiations in Geneva. As chair of the WHO Executive Board (2023-2024), she guided the organisation through a critical reform period, finalised the 14th General Programme of Work, and championed procedural changes to ensure greater transparency and accountability in the election of WHO regional directors.

On the treaty front, Al Kuwari served as vice-chair of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement, where she helped broker delicate consensus around the Pathogen Access and Benefit-Sharing (PABS) framework. She previously presided over deliberations during the 2021 special session of the World Health Assembly that initiated the accord, establishing her reputation among Member State delegations as a mediator capable of bridging North-South divides.

She rounded out her institutional footprint by chairing the WHO Eastern Mediterranean Regional Committee (2024-2025), anchoring her experience across the agency’s headquarters and regional tiers. That executive performance has drawn peer recognition beyond Geneva, including election to the US National Academy of Medicine in 2018, the WHO Director-General’s Health Champions Award in 2022, and the Best Minister Award at the 2024 World Governments Summit.

That delivery-oriented philosophy anchors her overarching campaign pitch: “The world already knows how to prevent most of the diseases that still occur,” Al Kuwari noted. “What it needs now is a WHO strong enough to turn that knowledge into results, in every country.”

Gulf competition and regional voting caucuses

Al Kuwari alongside Dr Hanan H. Balkhy: two prominent Gulf candidates whose parallel WHO bids create immediate sub-regional vote-splitting.
Al Kuwari (right) alongside Dr Hanan Balkhy: the two prominent Gulf candidates whose parallel WHO bids create immediate sub-regional vote-splitting.

Beyond individual credentials, Al Kuwari’s candidacy highlights the expanding financial and diplomatic footprint of the Gulf Cooperation Council (GCC) within the multilateral system. Qatar’s contribution to the WHO Programme Budget for the 2024-2025 biennium stands at $10.24 million – a figure modest in absolute terms compared to major sovereign donors like China ($201.82 million), Saudi Arabia ($100.12 million), or Belgium ($28.15 million), but distinguished by its internal structure. Crucially, $6 million of Qatar’s contribution was delivered as fully unearmarked core voluntary funding, providing WHO with flexible capital during an era of severe organisational downsizing and budget deficits.

Converting that financial commitment into an electoral majority, however, requires building broad coalitions far beyond Geneva and the Gulf. To secure WHO’s top post, Al Kuwari has pursued a cross-regional campaign strategy, aligning her platform with Global South priorities during high-level discussions in Addis Ababa with African Union Commission leadership. She followed this with extensive engagements at the Pan American Health Organization’s 63rd Directing Council in Washington, D.C., consulting PAHO Director Dr Jarbas Barbosa and regional health ministers on antimicrobial resistance, digital innovation, and equitable technology access.

Securing cross-regional backing is critical because Middle Eastern delegations rarely vote as a monolithic bloc. The concurrent nominations of Qatar’s Al Kuwari and Saudi Arabia’s Dr Hanan Balkhy further divide regional support, forcing both campaigns to look well beyond the Gulf for winning coalitions.

At the same time, both candidates stand to benefit from major structural tailwinds: a Director-General has never before been elected from the Eastern Mediterranean region. Furthermore, with only two women having served as WHO Director-General in the agency’s history, gender equity advocacy groups and women’s health coalitions will be actively pushing for female executive leadership at the helm of the UN health agency.

Key campaign challenges and diplomatic scrutiny

Al Kuwari receives WHO recognition for leading the FIFA World Cup health partnership, alongside persistent international scrutiny regarding occupational safety and migrant worker health.
Al Kuwari receives WHO recognition for leading the FIFA World Cup health partnership, alongside persistent international scrutiny regarding occupational safety and migrant worker health.

However, to secure broad member state backing, Al Kuwari must navigate significant diplomatic scrutiny across structural, normative, and operational fronts. While her campaign platform advocates for subsidiarity and a 100-day functional review to streamline WHO’s three levels (headquarters, regional, and country offices), traditional donors and observers are closely examining whether such administrative decentralisation – amid the GCC’s expanding footprint in global health – could weaken WHO’s centralised normative authority in Geneva.

Her proposed financing model also intersects with ongoing institutional debates. While her platform proposes expanding flexible funding through the Investment Round and the WHO Foundation, WHO’s external auditors have highlighted governance and disbursement shortfalls regarding the Foundation. Auditors have urged WHO to enforce contractual transfer targets, formalise donor engagement protocols under a Joint Strategic Plan to avoid donor overlap, and conduct regular joint performance assessments. To build donor trust, Al Kuwari will need to show that her financing proposal is accompanied by stronger, more transparent oversight.

On normative policy, while Al Kuwari has established strong credentials as a champion of maternal, newborn, and women’s health, liberal member states draw a sharp distinction between clinical health programmes and rights-based sexual and reproductive health and rights (SRHR). As a candidate nominated by a conservative Gulf state, she will have to prove that WHO’s global technical guidance on rights-based civil society partnerships, safe abortion access, and contraception would remain fully insulated from domestic political pressures.

Finally, her operational record faces questioning at the intersection of climate, worker safety, and human rights. Despite international recognition for leading the FIFA World Cup health security partnership, Qatar’s handling of the tournament raised persistent questions regarding migrant worker health and safety. Human rights organisations pointed to unaddressed gaps in extreme heat enforcement, occupational safety, and transparent mortality reporting among migrant construction workers. Compounded by Qatar’s fossil-fuel reliance and high per-capita emissions, these issues highlight the delicate task of reconciling domestic realities with WHO’s global climate-resilience and universal human rights standards.

A middle-power bridge builder for a fractured WHO?

Reflecting Qatar’s diplomatic posture, Al Kuwari seeks to convert her middle-power mediation skills into lasting institutional trust across a polarised World Health Assembly.
Reflecting Qatar’s diplomatic posture, Al Kuwari seeks to convert her middle-power mediation skills into lasting institutional trust across a polarised World Health Assembly.

As Qatar positions itself at the intersection of Global South advocacy and multilateral governance, Al Kuwari’s platform offers a synthesis: combining pragmatic executive management with non-aligned mediation to deliver a WHO that is “trusted because it is independent, sustainably financed, and valued because it delivers where people live.”

Having established a reputation in Geneva as a pragmatic consensus builder, she offers the operational discipline and non-aligned posture an overextended WHO requires. Yet her candidacy ultimately tests whether middle-power diplomacy can bridge deepening geopolitical fractures without diluting the agency’s technical rigour and independent normative authority.

Note: This article incorporates research findings and comparative evaluations from Rifat Hossain. Health Policy Watch reached out to Al Kuwari for comments but did not receive a response ahead of publication. Profiles will be updated as the campaign progresses, stay tuned on the microsite.

Image Credits: WHO, Felix Sassmannshausen/HPW, WHO/Antoine Tardy .

5. Countries and Potential Votes by WHO region
In May 2027, the World Health Assembly will select the next WHO Director General. Here are votes by region; but 20 countries would lose their eligibility to vote unless they paid back dues.

Presented as part of our brand-new series on the Election of the WHO Director General.  See our DG Election website for profiles of all the candidates and latest campaign news. 

What is the WHO Director-General election?

The Director-General is WHO’s chief technical and administrative officer. The WHO Member States will elect the next Director-General at the May 2027 World Health Assembly out of a list of three finalists, including all 194 member states that are up-to-date on dues and thus eligible to vote. Voting is by secret ballot. 

There are currently seven announced candidates, is this the definitive list?  

Nominations of candidates for this election closed on 24 September 2026. Currently there are seven announced candidates – although the full, final list will only be formally announced “on or shortly after 29 October 2026”.  

What happens after 29 October and who decides on the three finalists?

After nominations close, candidates are presented to member states, and there will be an official WHO candidates’ forum on 18 or 19 November, which the public can also access. 

In late January, the 34-member Executive Board will meet (EB160), shortlist five candidates and screen them, likely behind closed doors. The Board will then nominate up to three finalists for the World Health Assembly to consider at its May 2027 session (WHA80). A second candidates forum for the three finalists is then scheduled for March 15. 

Executive Board Countries Selecting DG Finalists
The WHO Executive Board will select three finalists for the May 2027 election of the new WHO Director General in January 2027. Here are the countries voting.

Can all WHA members vote? 

The 79th session of the WHA in Geneva, in May 2027 disqualified 20 member states from voting next year unless they pay back dues.

All 194 WHA member states are eligible to vote, including even the United States and Argentina, which announced their withdrawal from WHO – but were refused by the WHA for various legal reasons. But member states in arrears on their assessed contributions are ineligible to vote. And as of the last World Health Assembly, over a dozen member states, including the United States, were deemed to be ineligible to vote at the next Assembly – unless they had paid dues in arrears by that time.

Nine other developing nations would also have their voting rights suspended at the WHA in  2027, unless they catch up on dues: including: Burundi, Côte d’Ivoire, Djibouti, Equatorial Guinea, Nigeria, Panama, São Tomé and Príncipe, Timor-Leste, and Turkmenistan. And this in addition to another 10 states in arrears already in 2026, including:  Afghanistan, Dominica, Grenada, Myanmar, Saint Lucia, Somalia, South Sudan, Sudan, Venezuela (Bolivarian Republic of) and Yemen. Iran’s voting rights had also been suspended but were reinstated at the last WHA after they paid their dues.

Effectively, that means that out of 194 potentially eligible states, only 174 member states may actually be eligible to vote in the upcoming election – unless they cover outstanding dues in time. 

How long does the Director-General serve?

The Director-General is appointed for a five-year term and may be reappointed only once – meaning a ten-year term is the maximum possible. Following the May WHA vote, the newly elected DG will take office on 16 August 2027.  

How has the DG election process changed since WHO was first constituted in 1948?  

WHO’s ongoing Executive Board session in Geneva in February 2026.

Historically, the Executive Board selected only one finalist out of the candidates’ list, and submit  the name of that candidate to the World Health Assembly for appointment – giving just 34 member states near absolute power over the election. 

However, in 2012, during the second term of then-Director General Margaret Chan, the WHA adopted a resolution that changed the system dramatically giving the WHA the right to vote between three finalists selected by the EB. This was first applied in the 2017 election and still in effect today.  This followed earlier reforms during the 1990s that mandated EB and WHA voting by secret ballot and a maximum of two five year terms for any Director General. 

So 2017 was the first election in which the new system was tested? 

Yes, It was in 2017, when Chan was retiring, that the new system was put to a full-test as a result of pressures from member states for more representation. In January 2017, the EB shortlisted the initial list of 6 candidates to five, conducted interviews with those five, and then  short-listed the slate to three finalists. They included: the late David Nabarro (United Kingdom), Sania Nishtar of Pakistan (currently head of Gavi, The Vaccine Alliance) and Ethiopia’s nominee, Tedros Adhanom Ghebreyesus. Tedros went on to win the election in May and become the first WHO Director from the African region.  

And how will the system work in this election? 

The voting sequence will be much the same as in 2017.  In their January 2027 meeting, the EB will nominate three finalists out of the list of candidates. And then the final decision passes to the full Assembly, voting by secret ballot in May. 

If no candidate gets the support of two-thirds of eligible member states on the first voting round, a complex series of runoffs are held between the two top candidates, with the bar finally lowered to a simple majority for selecting the next director general. 

What further reforms were instituted in the 2017 election that are still in effect today? 

A Code of conduct was established for the election of the Director-General, which sets out agreed standards of conduct for Member States and candidates throughout the election process. A dedicated WHO page and handbook details all policies and relevant WHA and EB decisions.

Forums with Member States, both virtual and in-presence, were instituted by the WHA . This in turn has encouraged further public engagements with the candidates outside WHO, as is notably the case in the Global Health Centre’s Enhancing the WHO Director-General 2027 Election Process initiative, in which Health Policy Watch is a media partner.  

This year, as in 2017, candidates will be competing to secure a substantial majority in the WHA. This has democratized the process but also changed its political nature – making it more public-facing, stimulating more debate, and also giving more weight to the role of regional groupings of states with common interests in a candidate’s election.  See our new DG Election website for profiles of all of the candidates and latest campaign news.

Sources: Adapted from FAQs by Gian Luca Burci, Geneva Health Platform, Graduate Institute DG election site;  WHO — Election of the Director-General; WHO — Frequently asked questions; WHO — Process, as well as Health Policy Watch — WHO nominations close.

Image Credits: WHO/X, WHO/X.

The climate discussions took place under heavily polluted skies from wildfires in Indonesia.

KUALA LUMPUR – As scientists, economists, financiers, and policymakers gathered to discuss the impact of climate at the Global Tipping Points conference last week, the air quality in the Malaysian capital was ranked among the worst in the world.

Toxic smog from fires in Indonesia enveloped the city and closed schools as conference delegates discussed how to prevent climate “tipping points” that could affect the world’s core functioning and future.

“A tipping point in any system is where amplifying feedbacks take over, where they’re strong enough to support a self-propelling change in that system,” said Tim Lenton, chair of Climate Change and Earth System Science at the University of Exeter and one of the conference organisers. 

Once a climate tipping point has been crossed, the damage can become self-reinforcing and irreversible. 

For example, once the ice sheets in Greenland and West Antarctica collapse, the process could be slowed but not stopped. Its effects would ripple through changing ocean currents, ocean acidification, and monsoon drying, pushing other systems towards their own limits.

“Every year over that threshold level of 1.5º [above the pre-industrial temperature level] of global warming is going to increase the risk of tipping these critical life support systems.” 

The 2025 Global Tipping Points report estimates the tipping point for the ice sheets at around 1.5°C of warming above pre-industrial levels. The world is now at around 1.35 to 1.4°C.

Climate scientist Tim Lenton showed a map of how global tipping points are connected.

The conference, hosted by the Centre for Planetary Health at Sunway University, was the first to focus on tipping points in Asia. It brought together experts to discuss both the alarming science and the “positive tipping points,” such as cheaper solar power.

Delegates adopted a declaration calling for a united front, with finance, education, health, law, and technology, to address climate issues.

The declaration’s most concrete steps include setting up a communications coalition, a faith-based toolkit for planetary health, and an Asia Tipping Points report by 2028.

The declaration also notes that “health is where the crisis is felt first, and where action pays back fastest”. 

“Systems built for profit rather than people push their costs onto our bodies: the products of four industries (fossil fuels, ultra-processed food, tobacco and alcohol) cause at least a third of all deaths worldwide.”

It notes: “Health is the fastest lever: it must drive climate action rather than follow it, and health outcomes must be built into infrastructure and climate finance from the start, with health impact assessments showing decision makers the gains before they decide.”

Alan Dangour (left) of the Wellcome Trust.

Earlier, Alan Dangour, Wellcome Trust’s director of climate and health, told the conference:  “Health makes climate change personal”, with the impact “felt by people, by communities, by children, by parents.”

“Using health as a cooperation mechanism allows the scientists rather than the politicians [to lead],” Josselyn Mothe, a WHO Asia-Pacific technical officer on air quality and health, told Health Policy Watch.

At the moment, however, “the health dimension is not embedded into [regional] action,” Mothe added. Health is not yet an “action lane” in frameworks such as the haze agreement of the region’s main political bloc, ASEAN.

“We are not a region to be rescued,” said Sultan Nazrin Muizzuddin Shah in the keynote address. “We are, in significant part, a region where the rescue is already underway, however unevenly, however incompletely.” 

Bringing the conference to Kuala Lumpur, said co-chair Jemilah Mahmood, would “spotlight South and Southeast Asia’s lived realities and accelerate the positive tipping points we need for a healthier planet and future.”

Climate effects in Asia Pacific

A 2024 study by the Asian Development Bank estimates that climate change could reduce economic growth of developing Asia-Pacific by 17% by 2070 under a high-emissions scenario, and by as much as 41% by 2100.

This year’s El Niño, supercharged by climate change, is expected to bring more extreme events to the region. The fires in Indonesia are the worst in more than a decade, with about 175,000 people already experiencing respiratory illness since August. 

Vietnam’s Mekong Delta, a global rice bowl that feeds 90 million people, is bracing for severe drought and saltwater intrusion. In India, monsoon rain is about 12% below the annual average, yet heavier downpours have triggered floods and landslides.

At the same time, the region is also home to more than half the world’s population, growing economies, and manufacturing capacity that leads the world in solar panels and electric-vehicle batteries. 

The conference’s small scale put together financiers, faith leaders, academics, and health professionals, some of whom rarely talk to one another, in a region that bears a heavy impact. 

The health test will come soon at COP31 in Antalya, which opens on 9 November with a Health Day but gives health no formal place in the negotiations.

Image Credits: Minh Tran, Annice Lyn / Sunway Centre for Planetary Health.

Low- and middle-income countries took 19 of the top 20 places in a new ranking of how national climate plans address health. Fewer than one in 10 plans put a price on climate change’s health toll, and just two calculate the return on protecting people from it.

Low- and middle-income countries that contribute little to global warming have done the most to plan for its toll on health, while the major economies behind more than half the world’s emissions barely consider it in their latest climate commitments, filed with the UN ahead of next month’s COP31 summit.

The findings come from a global scorecard released this week by the Global Climate and Health Alliance (GCHA), a network of more than 300 health organisations. It graded 117 national climate plans, including a joint plan covering the European Union’s 27 member states, on how seriously they address health, from heatstroke and malaria to whether governments set aside money to protect clinics from floods and heatwaves.

The 10 best-scoring countries produce about 1.5% of global greenhouse gas emissions, according to EU data. Ten large economies that scored fewer than 10 of a possible 32 points, among them China, the United States, India, Russia and Saudi Arabia, produce more than 60%.

India, the world’s third-largest emitter, scored two points. Its plan does not name a single air pollutant, despite one of the world’s heaviest death tolls from dirty air.

Jess Beagley, GCHA’s policy lead, said in a statement that the ranking reflects “lived realities” in countries that “do not have the luxury of pretending that climate change and health can be separated.”

The plans, known as Nationally Determined Contributions (NDCs), are the climate commitments countries make under the 2015 Paris Agreement. Their content is voluntary, but governments must update them every five years. This round sets out how each country will cut emissions and protect its people from a hotter world through 2035.

Those commitments offer the clearest preview of what governments will bring to COP31, which opens in Antalya, Türkiye, on 9 November.

The UN climate body’s most recent tally, covering the first 64 new plans, submitted by September 2025, found they would cut emissions 17% below 2019 levels by 2035. Holding warming to 1.5C requires a cut of about 60%.

In September, the UN Environment Programme concluded that overshooting the 1.5C limit is now unavoidable.

“Climate change is not a forecast”

Mounting climate and environmental health challenges underscore civil society calls for Spain to nominate Dr María Neira for WHO Director-General.
Mounting climate and environmental health challenges are creating a perfect storm harming people’s ability to lead healthy lives around the world.

Sylvain Kalsakau, Vanuatu’s ambassador to the UN in Geneva, gave the keynote at the scorecard’s launch at the Geneva Graduate Institute on Wednesday. “I come to you from a country of 83 islands, where climate change is not a forecast,” he said. “It is a clinical reality.”

“Vanuatu cannot adapt its way out of a crisis that others continue to fuel,” he added. “No seawall, however tall, and no health system, however resilient, can keep pace with unchecked warming.”

The task before Antalya, said Suerie Moon, director of the institute’s Global Health Centre, is to make sure health is “not only mentioned in NDCs, but actually integrated” into policy, financing and action on the ground.

Top scorers count the lives at stake

Colombia topped the ranking with 29 points, taking full marks in every category but one. Its plan recognises the right to health, ties climate action to the defence of life and sets a target to cut black carbon, a soot pollutant that both warms the planet and damages lungs.

Nigeria came second with 25 points. Its emissions target is also one the independent Climate Action Tracker judges consistent with the country’s fair share of the effort to limit warming to 1.5C.

Nigeria’s Health Ministry modelled what the plan could deliver. Cleaner air could prevent more than 20,000 deaths from respiratory infections, heart disease, stroke and lung cancer, and save about $7.8 billion, said Dr Zakariya Mohammed, who heads the ministry’s Climate Change and Environmental Health division.

A working group of more than 40 members, drawn from across government, donors, academia and civil society, drafted the plan’s health component. “We are discussing together, making decisions together,” Mohammed said.

Cambodia, in third place with 24 points, commits to training 21,000 health workers and upgrading 100 health facilities to withstand climate shocks.

“Health comes up in many different areas, and it’s not just one category, and that’s why they’re scoring high,” said Nova Tebbe, the GCHA post-doctoral researcher who led the analysis and graded many of the plans herself. The top scorers, she said, are “thinking about health in a cross-cutting fashion and not just in one area.”

Major emitters near the bottom

Japan and New Zealand also scored two points, among the lowest in the ranking. Japan’s plan earned points only for listing three greenhouse gases it intends to cut. Tokyo went on to endorse a voluntary plan to prepare health systems for climate change at COP30 in Belém, Brazil, months after filing its national plan.

Among other major emitters, South Korea scored four points, Russia six and Brazil seven. Saudi Arabia, the world’s biggest oil exporter, also scored seven. China and the UK scored nine each, as did Australia, which will preside over the negotiations at COP31.

The United States scored seven, though its plan is no longer active after Washington quit the Paris Agreement.

“What we do at home only matters if it is matched at a global scale, above all by the largest emitters,” Kalsakau said. Governments, he added, “still spend enormous sums subsidizing fossil fuels, the very products that make our people sick.”

Health on paper, not in emissions targets

Smoking chimneys air pollution
Smoking chimneys at a traditional thermal power station, powered by fossil fuels, illustrate the nexus of air pollution, climate and health impacts.

Canada scored 16 and the European Union 12, above the average of 11.8. Even so, Climate Action Tracker finds both of their emissions targets consistent with warming of up to 3C, double the Paris Agreement’s 1.5C limit.

The scorecard measures how a plan treats health, not how hard it cuts emissions. GCHA set its scores beside the tracker’s ratings to see whether the two line up. They did not.

The tracker’s ratings cover only 17 of the 117 plans. Among those, the plans it judged “critically insufficient”, consistent with more than 4C of warming if every country followed suit, scored higher on health, on average, than those it judged “insufficient”, consistent with 2C to 3C.

The sample is small, the report notes, but greater attention to health “does not translate to increased climate action.”

The United Arab Emirates, which the tracker counts among the world’s leading fossil fuel producers and exporters, placed in the top fifth of the ranking. It was one of only eight countries to earn full marks on air pollution. The tracker rates its overall climate effort “insufficient” and says it plans to keep expanding its oil and gas activities.

“I think this really just shows that though you may score quite well on the scorecard, the level of ambition may not be there and must be improved as well,” Tebbe said.

“Often, health is considered to primarily be an issue associated with adaptation considerations,” said Tola Klabough, a GCHA project analyst. Governments that ignore its links to emissions cuts risk “charting a course to a world where health systems are overwhelmed,” Klabough said.

Türkiye, the COP31 host, scored 14. The tracker rates its target “critically insufficient” and says it would let the country’s emissions plateau or rise over the next decade.

Costing plans is hard, financing them harder

Even Nigeria, among the most ambitious, is running up against the cost of delivering its plan.

“It requires a lot of resources to implement the healthy NDC,” Mohammed said. “Quite a number of the interventions are costly.”

Much of that work falls to other ministries, he added, because the health gains the plan counts on come from action in sectors such as energy and agriculture. “Most of the determinants of health lie outside the health sector,” he said.

Nigeria’s deeper emissions cut is also conditional. Climate Action Tracker says the country needs international finance and support to bring that target in line with 1.5C.

Only nine of the 117 plans put a figure on what climate change will cost in lost health, the scorecard found. Just two, Nigeria’s and Timor-Leste’s, calculate what protecting health would return.

“Put a price tag in your NDC,” Kalsakau told health ministries. “A costed health component is an investment proposal. An uncosted one is a wish.”

WHO review finds health mentioned, rarely funded

The World Health Organization’s own review of the plans, due next week, points to the same gap. Nine in 10 of the 140 plans it examined mention health, the same share WHO counted in 2022, said Amy Savage, a technical officer in WHO’s climate change, energy and air quality unit, who also spoke at the launch.

Only 32 estimate what their health measures would cost. Just 10 say they would pay for any part without outside help.

“We consistently hear from countries that the greatest barrier to implementation of their climate change and health plans and priorities is a lack of finance,” Savage said. “And yet health still remains chronically underfunded within climate finance mechanisms.”

Fine particles and nitrogen dioxide, the fossil fuel pollutants most harmful to health, are largely missing from the plans. Only five countries set targets for black carbon. Outdoor air quality receives less than 1% of development funding, according to the Clean Air Fund.

“Governments must grasp that air quality action is a vital part of effective climate action,” said Jeni Miller, GCHA’s executive director, “and that people’s health and lives are at stake with both.”

Outside the negotiating room

COP31 will feature major battles over the future of climate financing for low-income nations. With health sitting outside the formal negotiations, the odds of securing major financing are slim.

For now, health has no formal negotiating track in Antalya. Türkiye’s presidency has placed “dynamic and resilient health systems” on its action agenda, a voluntary programme that runs alongside the talks, and will hold a Health Day on 9 November.

“For governments specifically going to COP31, we would also call for health to be included in the negotiated outcomes,” Savage said.

The Belém health plan has gathered at least 33 country endorsements since its launch at COP30. “But momentum is not delivery,” Kalsakau said. Countries pledged no new funding for the plan at its launch, Health Policy Watch reported at the time.

Less than 0.5% of multilateral climate finance reaches health, according to WHO estimates. Brazil has proposed a new COP31 agenda item on climate finance, expected to focus on what developed countries owe developing ones under the Paris Agreement.

“Without finance to enable lifesaving adaptation across sectors, the burden on the healthcare sector will be overwhelming,” Beagley said.

“Many of the countries where we work today are repeatedly asking for climate funding, but they’re not receiving it,” said Alexandra Malm, who coordinates climate, environment and health advocacy for Médecins Sans Frontières (MSF). “It’s just too little, too slow.”

The situation is “profoundly unjust,” Malm said later in the discussion, because “the people that are the most affected are the ones that have contributed the least to what is happening.”

Image Credits: Peter Mammitzsch, Alexandre P. Junior via Pexels, INGImage.

Independent journalism is increasingly important to understanding the political and financial forces shaping global health, yet the reporters covering these decisions face growing pressure and an uncertain financial future, according to Priti Patnaik, founder and editor of Geneva Health Files.

Speaking with Dr Garry Aslanyan on the Global Health Matters podcast’s Trailblazers with Garry series, Patnaik described the challenges of reporting on international health negotiations, where decisions affecting millions are often made behind closed doors.

“International diplomacy is a deeply unequal field,” she said, pointing to the limited resources available to smaller country delegations and the institutional structures that influence which proposals gain traction.

Patnaik launched Geneva Health Files in April 2020, as COVID-19 forced international negotiations online and increased demand for independent reporting from Geneva. Today, the reader-funded publication reaches approximately 7,000 readers across 150 countries.

Trained in science and financial journalism, Patnaik argues that global health reporting must examine the economic, political and historical forces behind health decisions rather than focusing narrowly on individual diseases.

“Science is technical, but it’s also political,” she said, adding that the political dimensions of global health are frequently overlooked.

That approach has attracted criticism from governments and other stakeholders.

“Global health is a political landmine,” Patnaik said. “No matter what you write and how you write, you’re going to step on toes.”

Financial sustainability remains another challenge. Despite six years of publishing, Geneva Health Files has yet to become commercially viable, highlighting the difficulties facing specialized independent journalism. Nevertheless, Patnaik remains committed to reporting stories that might otherwise go untold.

“If you don’t tell stories the way we do, a lot of the stories will not get told,” she said.

Listen to more episodes on Health Policy Watch >> 

Image Credits: Global Health Matters Podcast.

BANGKOK- Act fast and use the super-pollutant emergency brake to save lives and limit global warming. This is the message to governments and the private sector delivered by experts at the UN-hosted Climate and Clean Air Coalition (CCAC) annual conference this week in Bangkok. 

They are urging climate negotiators at the upcoming Climate Change Conference in Antalya, COP 31, to create a formal roadmap to tackle air pollution and global warming at once, 

Until now, UN Climate conferences have focused mainly on strategies to reduce carbon dioxide (CO2), the gas which is most responsible for global warming, long-term. 

But super-pollutants, also known as short-lived climate pollutants, only remain in the atmosphere for weeks or at most, a decade or two  – as compared to centuries for CO2. That means rapid reductions in these pollutants, most of which also are major contributors to air pollution, would also slow global warming significantly at a time when the world is ill-prepared for rapid changes. 

Potential gains of $1.5 trillion a year

Air pollution
The cost of air pollution inaction, per a CCAC analysis.

To convince governments, the experts cite estimated gains of $1.5 trillion a year for the global economy. Other numbers are equally stark; the experts hope it will persuade both finance and health ministries. 

These numbers come from fresh assessments made by researchers in a CCAC report, Hidden Assets, which adds up the health and economic benefits of cutting super-pollutants, including methane, black carbon, and ozone. 

What is CCAC? 

Super pollutants Climate change
CCAC, part of the UN Environmental Programme, is a voluntary partnership of over 200 governments and other organziations dedicated to protecting climate and clean air through tackling super pollutants. Above, a modeling scenario published by CCAC.

The CCAC is a UN Environment Programme (UNEP)-hosted initiative. 

Its 102 country partners and territories aren’t obliged to adopt or even consider its findings. Yet representatives from more that 60 countries signed up for the conference. 

Those driving the coalition are keen to build momentum and political support for action by governments. “This translates into a language of policy that a finance ministry will understand,” Lorenzo Santucci, of a UN agency, ESCAP, said on the opening day, Tuesday. 

Political case against pollution

“You will see benefits of this within one political cycle,” said Michael Rattinger of the Asian Development Bank at a plenary session. He was stressing how quickly political leaders can see the gains, compared with the decades it takes to see results from cutting CO2 emissions.

The super-pollutant approach calls for immediate but doable steps to cut air pollution and so avoid as much as 0.34°C of warming by 2050. This matters because, as the UN confirmed last month, overshooting the 1.5° is inevitable. The challenge now is to bring warming back down to 1.5°.

The conference’s theme is ‘To Reduce Short-Lived Climate Pollutants’ (SLCPs), the technical term for super-pollutants. 

What are super-pollutants?

Climate pollutants
Key climate pollutants are also harmful to human health.

Besides methane, ground-level ozone and black carbon, super-pollutants include Hydrofluorocarbons (HFCs) and volatile organic compounds (VOCs). They are mostly emitted by burning fossil fuels and biomass, and by agriculture, especially meat production. The largest near-term climate benefits would be achieved with cuts in methane, ozone, black carbon and HFCs, the coolants used in air conditioners and refrigerators. 

Short lived means the warming and pollution effects of these emissions last from minutes, like volatile organic compounds or VOCs, to about a decade, like methane. In contrast, CO2 emitted today will keep warming the planet for centuries. 

A vent stack at a gas processing station in the oil fields of Romania. The vent stack releases invisible methane into the atmosphere, captured in a specialised infrared camera that can visualise methane emissions. Leaks of methane from oil and gas installations is a major contributor to climate change.

Of all these, methane stands apart. It’s the second most impactful greenhouse gas after CO2. It is not itself an air pollutant, but it traps more heat far more powerfully than CO2, and it reacts with other chemicals to form ground-level ozone, a lethal air pollutant.

Methane comes from oil and gas production, from waste and agriculture, especially livestock, and stays in the air for about 10 to 12 years. 

The Hidden Assets report puts a health cost now on global warming and air pollution. Steven Stone of UNEP told Health Policy Watch (HPW) that “the health costs actually impact now. They’re the here and now. They are lung disease, cancer, and respiratory problems. And this is what the hidden asset brings out. There’s a real advantage to dealing with it now, by avoiding these costs, which are market costs, their financial costs.”

Air pollution and climate change- the costs

CCAC
Reducing key climate pollutants translates to tangible health benefits, per CCAC’s newest report.

By 2050, cases of stroke attributable to air pollution could rise 65%, heart attacks by 78% and dementia by 83% by 2050 in the no-action scenario. Every dollar invested can yield $15 in benefits, rising to $26 in Africa and $21 in South Asia. 

Taking action will cut annual deaths from air pollution to about 5 million or fewer avoiding an estimated 144 million avoided deaths by 2100. 

Without action, annual deaths attributable to air pollution will rise from about 7-8 million now to around 15 million annually by the end of 2100.

Deaths and disease burden estimates from fine particulate matter and ozone in different climate scenarios, per the CCAC 2026 report.

Taking action will cost $9 billion a year. 

Inaction will cost $1.5 trillion a year. 

Taking action will avoid 0.34°C of warming by 2050, and as much as 1.4°C by 2100. 

Without action, warming will reach 3.2° by 2100; we’re now at about 1.5° above pre-industrial levels, the limit the 2015 Paris Agreement sought to ideally not cross. 

Can CCAC succeed?

CCAC Bangkok
Panellists discuss super-pollutants at CCAC’s annual meeting in October, held in Bangkok.

CCAC met in Bangkok in 2026, unveiling the launch of a report of the economic and health case for climate and clean air action.

Senior CCAC researchers hope the message from this month’s convening can echo in ways that the outcomes of COP conferences, the main global climate process, have not – precisely because it is different. 

Additionally, COP agreements need consensus; CCAC countries join voluntarily, and each agreement is country-specific and not dependent on consensus by all members. So while incorporation into formal COP commitments would be optimal, it’s not a requirement for action. 

Kevin Hicks, a senior author and project coordinator of Hidden Assets, told HPW that CCAC member-countries are increasingly writing SLCP measures into their national pledges, or Nationally Determined Contributions (NDCs).

The commitments are updated by countries every five years, under the terms of the 2015 Paris Climate Agreement. 

NDC complements the UN Framework Convention on Climate Change (UNFCCC) COP negotiation process. 

Says Hicks: “One of the things that you’re trying to do with the Hidden Assets report, with the economic assessment, was to show that you can mainstream air quality into the climate debate and still get climate progress.”

“You can get the benefits (of clean air) very soon, in the next 10 years,” Prof Shuxiao Wang of Tsinghua University, Beijing, told HPW. When clean air and climate action are integrated, countries can prioritise the sources with the greatest benefits, she says. But they must act fast. 

‘World’s worst air pollution’

Delivering clean air in the Indo-Gangetic Plain and Himalayan Foothills,  which Ashish Tiwari of the Kathmandu-headquartered International Centre for Integrated Mountain Development (ICIMOD) called the “World’s Worst Air Pollution” hotspot, will be hard. 

Tiwari pointed out other challenges. The region has the “world’s most difficult geopolitical situation”, he said, referring to tensions between India, Pakistan and others. Air quality monitoring is still sparse: India needs 2,000 monitors but has about 600; Nepal has far fewer, he pointed out. While some countries agree on the goal of ‘35 by 35’ – reducing air pollution levels to 35 micrograms per cubic metre of PM2.5 by 2035 – but where is the financing, he asked. 

Super pollutantsAir pollution
The Indo-Gangetic Plain has been dubbed “the world’s worst air pollution,” seen here at the CCAC conference in Bangkok, October 2026.

To overcome these hurdles, Tiwari says, national air quality management plans need to be harmonised with regional efforts. 

Delays in climate-pollution action

CCAC’s strategy may differ from the UNFCCC’s COP process, but the pace is similar. 

It took 28 years for fossil fuels to be named in a final COP agreement (COP 28, in 2023). CCAC was launched  in 2012; the scientists, Hicks says, gave action a five-year window. Fourteen years later, it is yet to pick up pace. 

The CCAC researchers have made it easier for countries to act: they’ve listed 25 steps that cut air pollution, limit global warming, improve health outcomes and boost economic growth. That is a win-win, but to adopt them, government leaders need to see how they can also be a political win. 

Image Credits: WMO, CCAC, CCAC, Clean Air Task Force , Ashish Tiwari.

Tents fill the Al-Rimal neighbourhood of western Gaza City on 30 September 2025, during the Israeli offensive on the city, as many displaced families remained despite evacuation orders.

KHAN YOUNIS, Gaza –For Faten Youssef Ayyash, the gap between promises and action is measured in an earthen pit. She dug the drainage pit around her tent in Al-Mawasi, a crowded coastal area west of Khan Younis in southern Gaza, so that water would not pool around the living quarters for her and her six daughters.

Water that collects in the pit, when the rains start to fall, will probably be used for dishwashing as well.

“I’m afraid this water brings insects, flies and disease,” said Ayyash, 43, who has been displaced from Rafah, a city on Gaza’s southern border with Egypt, three times since the war began.

All six girls caught chickenpox and gastroenteritis, one after another, and she fears winter rain will flood the tent as it did last year, since there is no escape route for rainwater – or the sewage and waste that it sweeps up in its path. Rats thrive in the waste, however, chewing through the family’s clothes and food.

“This has been going on for three years,” she said.

Only a small fraction of the billions pledged has actually reached Gazans 

Sewage runs alongside tents housing displaced families in the Al-Nafaq area of Gaza City, 14 October 2026.

A little more than a year after the Israel-Hamas ceasefire began on October 10, 2025, donors have pledged billions of dollars to rebuild Gaza, but only a small fraction has reached the some 2 million people in need.

At its first meeting in February, the US-led Board of Peace, which lists 28 founding members, announced about $17 billion in pledges for Gaza, including $10 billion promised by the United States and roughly $7 billion from nine other members, among them the United Arab Emirates, Qatar, Saudi Arabia and Kuwait. A joint EU, UN and World Bank assessment puts Gaza’s recovery needs at $71.4 billion.

By late September, only about $280 million of the pledges had been transferred to the board. On September 23, the board proposed a six-month, $2.45 billion plan to start rebuilding.

The fate of other pledges remains equally hard to trace – like the Team Gaza Initiative, a separate €884 million fund including partners from 13 governments, the World Bank and the European Investment Bank, launched by the European Commission in July.

Speaking at the UN General Assembly in September, European Commission President Ursula von der Leyen announced another €103 million in aid to displaced Palestinians across Lebanon and the Israeli-occupied Palestinian Territories (OPT), as part of a larger aid package to Gaza.

Water, waste and sanitation services collapsed

Informal rubbish dumps are spread across a tent camp for displaced families in the Al-Nafaq area of Gaza City, 14 October 2026. Residents say the waste has become a breeding ground for rodents and insects.

Since the ceasefire, the tent camps where most Gazans now live are no longer bombed as they were, but water, sanitation and waste services have collapsed and infectious diseases once held in check spread routinely, especially among children, pregnant women and newborns.

Before the war, most Gazans had access to a piped water supply supported by nearly 200 small and mid-sized desalination plants and three water lines bringing in piped water from Israel’s own water authority.

Most of the local desalination plants were destroyed in the war, and service from Israel has only been partially restored. What little piped water is available comes from local councils pumping local wells and running desalination plants on generators. Aid agencies, led by UNICEF, bring water in tanker trucks into the camps.

Toilets drain into latrine pits, many of them unsafe or open, and rubbish piles up because dumpsites are full. Aid groups spray for pests but reach only a third of sites.

In early August, 91% of households surveyed by UN partners faced moderate to high water insecurity. More than 1.3 million people in Gaza have access to less than six litres of water per person per day for drinking and cooking, said the United Nations Office for the Coordination of Humanitarian Affairs. That is against a WHO recommended standard of 50 litres and a humanitarian emergency minimum of 15 litres for drinking, cooking and washing.

Some families of six to eight people share just one or two containers of water a day, Salha said, and that has to cover drinking, washing and bathing.

Faecal bacteria and pests

Rubbish piles up amid destroyed buildings and tents sheltering displaced families in the Al-Nafaq area of Gaza City, 14 October 2026.

COGAT, the Israeli military body that oversees aid to Gaza, said in a July report that water supplies exceed humanitarian standards, though it acknowledged that sanitation problems remain. It blames Hamas for obstructing aid.

But the data tells another story.

WHO testing found faecal bacteria in nearly 18% of water samples checked in August, and almost three-quarters of samples were not properly chlorinated.

Rats and other pests are seen in 80% of temporary shelter sites, and skin diseases are widespread in almost half.

Cases of scabies transmitted by mites, between January and March, according to the UN agency for Palestinian refugees (UNRWA), with hotspots in Al-Mawasi, where the Ayyash family lives.

Diseases linked to rodents also have been rising, according to another report by OCHA. Skin infections, including parasitic infestations, accounted for about a quarter of reported disease cases in Gaza in late September, according to OCHA’s latest report.

Failure to advance peace process leaves Gazans in an impasse

Map delineates the 2025 ceasefire “Yellow Line”, with red dots showing positions of Israeli military outposts.

The gap between aid promises and delivery, as well as the standoff over water and sanitation, are but two reflections of the impasse in the wider peace process, with Hamas agreeing to hand over its weapons in phases over three years, but only if Israel withdraws. Israel, which controls more than half of Gaza, says it will not withdraw until Hamas is fully disarmed.

A technocratic body meant to run services, the National Committee for the Administration of Gaza, began work from Cairo in January. But Israel denied its members access to Gaza, and so the committee has yet to enter the enclave, which remains divided by a “yellow line” denoting Israeli- and Hamas-controlled areas.

The impasse affects literally every aspect of Gazan’s access to goods critical for health, shelter, sanitation and food security.

Pledges of money are not the only barrier

Malnutrition is rampant in Gaza as supplies continue to be restricted.

Israel continues to restrict a wide range of what it regards as “dual use” that it says could still be used for military purposes.

Those range from tents and shelter materials to fuel, medicines, engine oil, spare parts and generator filters, Mohammed Salha, director of the Palestinian NGO Network (PNGO) in Gaza, told Health Policy Watch.

Local charities cannot bring them in at all, and only some international groups and UN agencies can, under heavy restrictions. No new generators are allowed in, and the old ones, in use for three years, have been repaired dozens of times, he said.

Gaza’s emergency drinking water system, which relies mostly on tanker trucks, still needs fuel for its trucks, engine oil for pumps and generators, and chemicals and spare parts for its desalination plants to operate, even partially.

In early October, OCHA reported that shortages of engine oil and spare parts had pushed southern Gaza’s remaining operational desalination plants to their lowest output and were causing generator shutdowns at health facilities.

Essential health items are in short supply

Essential health supplies are in short supply in Gaza.

 

Basic medical items are also in short supply.

In August, Médecins Sans Frontières (MSF) said Israeli restrictions were preventing the entry of supplies ranging from skin-disease ointments to the rubber seals needed for sterilization equipment.

In October, WHO urged Israeli authorities to stop treating essential medicines as “dual use” items, a classification Israel uses to restrict goods it says could also serve military purposes.

“The issue is not the promises or pledges made by international bodies, but the extent to which the Israeli occupation forces allow what is needed into the Gaza Strip,” said Salha. 

Displacement as a chronic condition 

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

More than 71,000 Palestinians were killed in two years of war, according to the joint assessment by the European Union, the United Nations and the World Bank. About 1.9 million people, almost the whole population, have been displaced, and almost 60% have lost their homes. About 1.7 million now live in some 1,600 displacement sites, most of them tent camps, according to the International Organization for Migration.

Israel’s “present policy on quality shelter is not acceptable”  Nickolay Mladenov, and Director-General of the Board of Peace and High Representative for Gaza, told the UN Security Council in August.

Disease on the rise – but hospitals only partly functioning

While patients are on the rise, most healthcare facilities are barely functioning.

According to WHO, as of September, only 19 of Gaza’s 36 hospitals were functioning even partially, and none fully.

Dr Ahmed Mehanna, director of health programs at the Al-Awda Health and Community Association, a local nonprofit, said its emergency department, especially the children’s section, sees 12 to 15 cases of gastroenteritis or diarrhea every day, and its skin clinic sees 50 to 60 patients a shift.

He thinks some cases are linked to dirty water. “But without lab equipment, doctors cannot be sure what is causing them. Clinics are also short of rehydration salts and skin creams,” he said.

Diseases like these have become common fare in Gaza’s shelters since early in the war.

Dina Helles, 30, fled Gaza City’s Shujaiya neighborhood in October 2023 and ended up in a school in Deir al-Balah, in central Gaza, sharing one classroom with three other families. That winter, her son Zein, then two and a half, developed constant diarrhea and severe dehydration and did not get better after treatment at Al-Aqsa Martyrs Hospital. “He caught the infection in the school’s shared toilets,” she said.

Babies are catching infections due to the unsanitary conditions.

Up to 180 babies are born in Gaza every day. The UN reproductive health agency, UNFPA, says nearly 4,000 pregnancy losses were reported in the first half of 2026, three times as many as in the previous six months.

Rawan Abu Ghali, 26, gave birth to her daughter Maha in October 2025 in Al-Zawaida, in central Gaza. Water was so scarce that she struggled to keep herself clean during pregnancy and after the birth, she said.

Maha, now one, has spots on her scalp, and a doctor blamed pollution and life in the tent, Abu Ghali said. Diarrhea and infection in pregnant women can lead to malnutrition and complications, Mehanna said. Malnourished mothers often give birth to underweight or premature babies, according to UNICEF, and low birth weight infants are about 20 times more likely to die.

Salha said many camps have no clean, private toilets for women and girls, or toilets people with disabilities can use.

Sewage and rubbish

Critical infrastructure in Gaza has been damaged by the conflict.

Every major sewage treatment plant in Gaza stopped working over a year ago, and 73 of its 84 sewage pumping stations have been destroyed.

Mohammed Musleh, mayor of Al-Maghazi in central Gaza, described the situation to Health Policy Watch as an “environmental and health disaster.”

About 85% of the sewage system has been destroyed, he said, and raw sewage goes into the sea or collects in ponds near homes and camps. Residents have dug about 320,000 makeshift pits, some on the beach at Al-Mawasi camp, where sewage can seep into already polluted groundwater reserves.

About a million tonnes of rubbish has built up in 323 informal dumps, he said, roughly the weight of three Empire State Buildings. He attributed this to the inability of municipalities to reach the main landfills.

“UNICEF or the Red Cross fund short work schemes in each municipality,” Musleh said. “Workers are hired for 45 days at a time and given donkey carts to collect rubbish and take it to the dumps.”

Families set up tents beside dumps and sewage ponds because there is nowhere else to go, he added.

Due to the Israeli military occupation, the majority of Gazans are now living on less than 30% of the enclave’s land, Salha of PNGO noted.

With winter looming only weeks away, Mehanna called for safe drinking water, regular rubbish collection and the draining of sewage ponds before then.

Sewage crosses all borders

The accumulation of trash and sewage during months of war exacerbates infectious disease risks in Gaza. Picture taken in 2024.

In 2024, the UN Environment Programme warned that sewage was already polluting Gaza’s beaches, coastal waters, soil and fresh water. Since then, the problems have only increased.

In September, OCHA reported that all six of Gaza’s wastewater treatment plants were out of action and 70% of its sewage pumping stations were out of service.

Some of that sewage reaches the sea, and some Israeli scientists suspect it helped feed a massive algae bloom that shut down five of Israel’s six major coastal desalination plants in late August.

Sewage discharged along the Gaza coast supplied nutrients that helped the microorganisms multiply, with unusually warm Mediterranean waters creating favorable conditions for rapid growth, according to Avner Rgoss, head of Ben Gurion University’s Climate Change Laboratory. 

Others were less certain that Gaza’s sewage was the main driver, noting that Egyptian desalination facilities in northern Sinai also were hit by the algae bloom.

Either way, the shutdown also led to another temporary interruption in piped water supplies from Israel in early September – supplies had been partially restored after the war-time halt to services,  according to OCHA.

In Al-Mawasi, Faten Ayyash is getting ready for the autumn rains, with the dishwater pit poised right beside her tent – and nowhere else to go.

“We are preparing for the worst. Winter is just around the corner, and we’re bracing for new problems with our health and our shelter,” she said. “The worst part is that we don’t know when this nightmare will end.”

This article is published in collaboration with Egab.

Ansam El-Kattaa is a Palestinian journalist from Gaza who works across print, radio and mobile journalism. She specialises in human-interest stories about civilian life during crises, and her work has appeared in Al Jazeera English, El País, TRT, The New Humanitarian and D+C Development and Cooperation.

Image Credits: Ansam El-Kattaa, cc/Al Jazeera , WHO, WHO, WHO/EMRO , WHO, WHO, OCHA, UNRWA .