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’

air pollutionClimate change
Peak air pollution levels in the Indo-Gangetic Plain – a region known for often toxic levels of 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 , University of Chicago , 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 .

Rural women often struggle to get access to health care.

On this International Day of Rural Women (15 October), countries need to commit to addressing the disparity between health services in urban and rural areas

Despite significant improvements in maternal health globally over the last few decades, where a woman lives can still determine whether she gets the health care she needs.

For millions of women in rural areas, reaching a clinic can mean travelling for hours, paying for transport they struggle to afford, finding someone to look after children, or losing a day’s work. Even after making the journey, the health worker, medicines or services they need may not be available.

In Suriname, for example, the hinterland lacks hospitals and pharmacies, and informal clinics provide basic healthcare, usually driven by local NGOs. To see a gynecologist and obtain pediatric care, rural women are compelled to travel long distances, usually under the supervision of the men in the family or village. 

Strengthening rural health systems and involving women in shaping them must be priorities for all countries, particularly in an era of declining external funding. 

 The International Day of Rural Women, observed annually on 15 October, provides an opportunity to draw attention to current inequalities in health care between rural and urban women and the actions needed to address them.

When distance becomes dangerous

Maternal health illustrates what the inequities look like. Access to skilled care before, during and after childbirth can be lifesaving: an estimated 260,000 women died from pregnancy- or childbirth-related causes in 2023 — more than 700 every day. Yet globally, 93% of births among women in urban areas were attended by skilled health personnel in 2023, compared with 77% among rural women.

Most pregnancies and births are straightforward, but complications can quickly become life-threatening. Severe bleeding, eclampsia, obstructed labour and other emergencies require skilled care, medicines and, sometimes, an emergency Caesarean section. For women in remote communities, the time required to reach emergency care can be decisive.

The World Health Organization (WHO) uses access to emergency obstetric care within two hours of travel time as an indicator of geographic access. In an obstetric emergency, a functioning facility several hours away may effectively be out of reach. Governments need to consider whether women can reach emergency care in time and whether facilities have the staff, blood supplies, medicines and surgical capacity to respond.

A midwife using a Dopler on a pregnant woman in a rural community clinic in Guatemala.

Rural women need full range of health services

The Committee on the Elimination of Discrimination against Women’s (CEDAW) General Recommendation No. 34 calls for accessible, affordable and culturally acceptable health services for rural women. These include access to the full range of health services throughout their lives, including contraception, maternal care, cervical cancer screening and treatment, services for sexually transmitted infections, safe abortion care, fertility services and care following sexual and gender-based violence. 

CEDAW also recognises that rural women may also face barriers in accessing mental health services, cancer care, treatment for non-communicable diseases, essential medicines and palliative care. For a woman with HIV, breast cancer, diabetes or hypertension, distance can mean delayed diagnosis, missed follow-up and long journeys to obtain treatment.

Early marriage, female genital mutilation and other harmful practices can compound the health risks faced by rural women and girls. Addressing their consequences requires accessible health services along with community support, and efforts to change discriminatory practices.

Patient privacy enhances access to care

Confidentiality is part of whether a service is acceptable and genuinely accessible. In small communities, privacy can be difficult to protect. A woman seeking contraception, abortion-related care, testing for a sexually transmitted infection, or help after violence may know the health worker personally. She may meet neighbours in the waiting room or worry that other people will learn why she visited the clinic. 

That can be enough to deter someone from seeking care at all. Good rural health services need private consultation spaces, clear standards on confidentiality and referral options for women who do not feel able to use a service locally.

People, supplies and transport

WHO estimates that around two billion people living in rural and remote communities do not have adequate access to essential health services. Shortages of health workers are part of the problem. 

The recruitment and retention of health professionals outside major cities remains difficult. Better incentives, professional support, continuing education and investment in locally based health workers can help. Midwives, nurses and community health workers can provide much of the essential care when they have the training, authority, equipment and supplies to do so.

 Referral systems are also important. A local clinic may identify that a woman needs specialist treatment, yet the referral can fail because transport is unavailable, the hospital cannot accept her, records do not travel with the patient, or she cannot afford the journey. A functioning system needs reliable emergency transport, clear communication between facilities and follow-up once a woman returns home.

 Telehealth can extend specialist advice, support local health workers and reduce some unnecessary journeys. Its usefulness depends on reliable connectivity, privacy and functioning local services. Examinations, medicines, laboratory tests, procedures, and emergency obstetric care still require in-person care.

Rights require accountability

Rural women face several barriers to wellbeing, including lack of access to quality healthcare, education, income and land.

Universal health coverage will not be achieved while large groups of rural women cannot obtain essential care. National data can conceal major differences between regions and between urban and rural communities. 

Governments need health data that show who is receiving care, who is being left behind, and where the barriers are. CEDAW has called for data on rural women to be disaggregated by geography, age, disability and socioeconomic status. Better data can show whether services are reaching women in practice and where additional investment is needed. 

Rural women should have a voice in the decisions that shape local health services. They know where transport fails, which services are missing, when opening hours are impractical and where privacy is inadequate. Independent rural women’s organizations can strengthen their participation, provide opportunities for collective action and help hold local authorities accountable for improving services.

 Improving rural women’s health also requires closer cooperation between the health, education and agriculture sectors. Together, they can help address the social and economic barriers affecting women’s health by improving girls’ education and expanding women’s access to land, income and opportunities for economic independence.

Where a woman lives should not determine whether she can obtain essential health care or survive a medical emergency. The right to health belongs to women everywhere.

 Ambassador Aashna Kanhai is Permanent Representative of Suriname to the United Nations Office in Geneva. 

Dr Haileyesus Getahun is the Chief Executive Officer of the Centre for Health Diplomacy and Inclusion, based in Geneva.

 

 

Image Credits: UNDP, International Confederation of Midwives, UN Women.

Germany’s top climate civil servant questioned a poor-country negotiator’s figure on how little climate finance reaches health. The resistance sets the stage for an uphill battle for the health world to get the urgently needed money to adapt to the climate crisis next month.

BERLIN – Germany’s top climate civil servant pushed back on Monday against a call from the world’s poorest countries for more climate finance for health. The money fight of COP31 opens officially in Antalya, Türkiye, next month. In the halls of the World Health Summit in Berlin, it’s already started.

Less than 0.5% of climate finance goes to health, Dr Sidi El Moctar, a Mauritanian health ministry official, told a World Health Summit panel. He wanted to know how the least developed countries, Mauritania included, could get more to address the health crises amplified by climate change.

“We say in French, le financement, c’est le nerf de la guerre,” said the official, who negotiates on adaptation for the Least Developed Countries group at UN climate talks. Money, as the French saying has it, is the “lifeblood of war” – a truism over three decades of UN climate summits as fights over financing dominate proceedings.

But Jochen Flasbarth, state secretary at Germany’s environment ministry, questioned the number before answering. “I would make some question marks,” he said about the figure, which the World Health Organization (WHO)  first published in 2021 and which was still being cited at COP30 in Brazil last year.

Health-specific climate finance reaching climate-vulnerable countries totals roughly $500 million to $700 million a year, about 2% of adaptation funding and the 0.5% of multilateral climate finance the negotiator cited, Health Policy Watch reported at COP30.

“Whenever we work on mitigation, it has an impact also on the health sector,” Flasbarth said. “When you narrow it down to how much money is going to the health sector, like hospitals, medical institutions and so on, then it might be smaller.”

Crunching the numbers 

Jochen Flasbarth, state secretary at Germany’s environment ministry, at the World Health Summit in Berlin on 12 October. He co-chaired mitigation talks at the pre-COP in Fiji last week.

The exchange, cut short as Flasbarth left the panel early for another engagement, previews a critical question for the health world that will return next month at COP31: will global health ever get a serious spot in the climate money conversation?

As wealthy governments count their emissions cuts as health protection, countries on the front line of the climate crisis say the clinics, cold chains and disease surveillance they need to survive heat, floods and outbreaks are unfunded. 

A special report from the WHO and Brazil, launched at COP30 in Belém last year, put the cost of direct health adaptation in those countries at more than $22 billion a year by 2035.

The case made by Flasbarth for mitigation as health spending is borne out by critical environmental threats like air pollution from burning fossil fuels, which causes about five million premature deaths a year. Cutting emissions could deliver major health gains and reduce pressure on health systems within years.

“However you quantify this, you come up with very large potential benefits in the near term, over and above the benefits of reducing the risk of dangerous climate change,” said Andrew Haines, professor of environmental change and public health at the London School of Hygiene & Tropical Medicine, who chaired the session. “Health is not just the province of the healthcare sector. So many determinants of health are social and environmental.”

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.

Germany put €4.7 billion of federal budget money into international climate finance in 2025, down from €6.1 billion a year earlier and short of the €6 billion a year successive governments had promised, according to a joint release from Flasbarth’s environment ministry and the development ministry last week. The release does not mention health.

“We’re clearly not doing enough,” EU climate commissioner Wopke Hoekstra told reporters at the pre-COP meeting in Fiji last week, as Pacific leaders pressed wealthy nations for more money.

“The world is expected to cross 1.5°C of global warming above pre-industrial levels in the next few years,” Hoekstra said. “That means we’re talking about survival of the world as we know it.”

In Antalya, health will have no formal negotiating track of its own. Türkiye’s health ministry plans a Health Day on 9 November, the summit’s opening day, and “Dynamic and Resilient Health Systems” is one of 10 themes in the presidency’s action agenda, a voluntary track outside the formal talks.

“There is some progress,” the Mauritanian negotiator said of the push to bring health financing into the climate talks. “But we need more voices in these rooms.”

Fighting over the same money

Comparison of adaptation financing needs, modelled costs and international public adaptation finance flows
in developing countries, per UNEP data.

Across all of adaptation, developing countries will need $310 billion to $365 billion a year by 2035, including for the climate-resilient health systems they are asking for, the UN Environment Programme estimates. But the international public adaptation finance reaching them in 2023 was $26 billion, down from $28 billion the year before.

A string of newer funds have popped up to chase what money remains as foreign aid and development assistance collapse globally across all sectors. The Pacific Resilience Facility, which entered into force in May, set out to raise $500 million. It had commitments for less than half of that when Fiji added $10 million at the pre-COP in Nadi last week, AFP reported.

The Fund for Responding to Loss and Damage, the headline achievement of COP28 in Dubai, had $822 million in pledges by April but only $449 million paid in. The fund has yet to disburse any money, and despite that, could face “liquidity issues” as early as next year, Climate Home News reported. Campaigners put developing countries’ loss and damage needs at up to $400 billion a year.

“Climate has gone down on the agenda with governments around the world,” said Katrín Jakobsdóttir, the former Icelandic prime minister who chaired the Pan-European Commission on Climate and Health convened by WHO’s European office. “AI and conflicts around the world are higher on that agenda. That does not mean that the climate crisis has gone anywhere.”

Adding to the funding crunch, more than 90% of what development banks provide for health adaptation arrives as loans rather than grants, a major barrier for low-income governments already struggling to service their debts.

In lower-income countries the IMF rates at high risk of debt distress, governments have cut education spending by 8% and health spending by 1% since 2019, the campaign group Debt Justice found in research published on Sunday. In 113 developing countries, servicing foreign debt cost more than education in 2025, according to UNESCO.

Mauritania paid $373 million to service its public external debt in 2024, World Bank data shows. This is more than half the total available health-specific climate finance that climate-vulnerable countries receive in a year.

“In Senegal, half of our revenue goes to creditors,” said Souleymane Gueye of the Senegalese campaign group FRAPP. “Education and healthcare share barely a quarter.”

Children suffer most from lead exposure.

HARIPUR, Pakistan – Unregulated industrial pollution and lead exposure are poisoning a generation, with four in 10 children in high-risk cities carrying unsafe blood-lead levels, exacerbated by toxic smog and weak enforcement, according to a UNICEF study.

Few months ago, Malik Ayaz Ahmed, 22, took a job at a lead-processing factory in Hattar, an industrial belt outside Haripur in Khyber Pakhtunkhwa, in the northwest of Pakistan.

He started work barely a month after a national study revealed that children living near his hometown’s factories had among the highest blood-lead levels ever recorded in Pakistan.

Weeks later, Ahmed fell seriously ill and was admitted to the district headquarters hospital. A clinical test seen by Health Policy Watch put his lead level above 103 micrograms per decilitre — nearly 30 times the safe threshold reference of 3.5 µg/dl.

“It was the test case that showed whether industry had followed any safety protocols to control lead exposure. It had not,” said Tariq Mehmood, executive director of the Human Unity Movement in Haripur, who has spent years documenting the toll of the Hattar industrial zone.

In Pakistan, lead battery manufacturing units and paint factories are major sources of lead exposure, while informal recycling of lead batteries is the main lead poisoning route.

The lead batteries market volume was estimated to be worth $1.65 billion in 2026, while in the paint industry 40% of solvent-based paint samples exceeded Pakistan’s legal lead limit of 100 ppm, with a maximum of 97,000 ppm.

Alarming pattern

Ahmed’s case is an adult echo of a much larger and alarming pattern disclosed by Pakistan’s government and UNICEF earlier this year. Four in 10 children aged 12–36 months in high-risk areas of seven cities carry lead in their blood at levels that the World Health Organization (WHO) considers unsafe.

In Hattar itself, 88% of children tested had elevated blood-lead levels, compared with just 1% in nearby Islamabad, the federal capital of the country. Researchers describe this gap as one of the starkest environmental health disparities documented anywhere in South Asia.

The study, “Ending Childhood Lead Poisoning: Evidence for Policy Action,” shared exclusively with Health Policy Watch,  tested 2,175 children across 21 sites in Pakistan’s major industrial cities, including Karachi, Lahore, Peshawar, Rawalpindi, Islamabad, Quetta and Haripur.

It found a national mean blood-lead level of 3.12 µg/dl, with one child registering 107.63 µg/dl, among the highest values ever reported in the medical literature.

UNICEF estimates that 47 million Pakistani children have blood-lead levels above the WHO threshold, and warns that global modelling suggests the true toll could be far worse, with up to eight in 10 Pakistani children potentially affected. This is among the highest rates in the world. The organisation puts the economic cost of the resulting lost cognitive potential at 6–8% t of GDP, or roughly $25–35 billion a year.

“Protecting children from lead exposure is a national public health priority,” said Muhammad Aslam Ghauri, former federal secretary of the Ministry of National Health Services, Regulations and Coordination, calling for stronger surveillance and enforcement.

UNICEF Representative in Pakistan Pernille Ironside was blunt about the stakes: “There is no safe level of exposure to lead for children whose harmful effects are irreversible.”

There is no known safe level of lead exposure.

Where lead meets smog

Public health experts and environmental researchers insist that Pakistan’s lead emergency is unfolding inside one of the world’s most polluted airsheds, and the two toxins appear to interact.

“Co-exposure to air pollutants like particulate matter can significantly affect lead absorption, bioavailability and overall metabolism,” said Dr Ammara Naeem, a consultant paediatrician at Sulaiman Al Habib Hospital in Saudi Arabia.

Fine particulate matter can chemically alter how lead behaves in the body, trigger inflammation, and act as a carrier that deepens exposure, meaning a child breathing Pakistan’s smog is likely absorbing more lead, not less, than the same child in cleaner air, explained Naeem.

Islamabad-based climate policy advocate  Dr Zainab Naeem of the Sustainable Development Policy Institute points to shared sources: old paint and mining residue in Khyber Pakhtunkhwa, informal battery-recycling smoke, e-waste burning, and the open incineration of industrial waste.

“There are no safety protocols for battery recycling; this informal smoke damages [health], and there is a problem of child labour in the industry, especially in the big cities,” she said, adding that weak coordination between federal and provincial environmental agencies has let both crises fester in parallel.

The numbers bear this out. Pakistan ranked as the world’s most polluted country in IQAir’s 2025 World Air Quality Report, with an average PM2.5 concentration of 67.3 µg/m³ – 13.5 times the WHO annual guideline of 5 µg/m³.

As of mid-February 2026, IQAir’s real-time index placed Lahore as the third most polluted major city on Earth and Karachi eighth, with AQI readings above 200 recorded across the country’s urban centres.

Pakistan’s own National Environmental Quality Standards permit ambient air lead levels of up to 1.0 µg/m³ annually, but researchers and lawyers alike say enforcement of that ceiling is negligible outside a handful of monitored zones.

The World Bank has repeatedly quantified the economic toll of dirty air. Its Pakistan Country Climate and Development Report estimates air pollution imposes economic losses equivalent to roughly 6.5% of GDP annually, and health costs equivalent to roughly 9% of GDP in 2019.

The Federal Minister for Climate Change, Dr Musadik Malik, framed the two crises as inseparable: “Air pollution is a major challenge to human health,” he said, calling for reforms across industry, transport and energy, tighter monitoring and enforcement, and wider adoption of electric vehicles.

In a statement he said clean air is a basic right of every citizen, describing joint national efforts on the environment as unavoidable — language that mirrors, almost verbatim, the coordinated-action rhetoric now attached to the lead response.

A patchwork of poorly enforced laws

Pakistan is not without a legal architecture. The Pakistan Environmental Protection Act, 1997, together with the National Environmental Quality Standards, hazardous-substance rules and provincial environmental laws, gives regulators broad powers to monitor pollution, investigate violators and issue Environmental Protection Orders.

“The more significant weakness is implementation and enforcement rather than the complete absence of law,” said Advocate Bina Faraz, an environmental lawyer.

Faraz argues there is a strong case for regulating air pollution and toxic-metal contamination jointly, as industrial emissions routinely poison air, soil and water through the same smokestacks.

“Treating air pollution and toxic-metal exposure as entirely separate regulatory silos can leave gaps in accountability,” she said, calling for independent monitoring of emissions and blood-lead levels alike, and a legally binding action plan with enforceable timelines, mandatory reporting and defined penalties, rather than the largely aspirational plans Pakistan has produced to date.

Industry, for its part, does not fully dispute the picture. Malik Ashiq Awan, chair of an industries association covering the Hattar zone’s roughly 418 factories, acknowledged there are “health issues because of industry,” including from lead-battery units, alongside ongoing air pollution and water contamination.

He said filtration systems needed to curb emissions are prohibitively expensive to install and operate, but added: “I support it should be checked.”

Haripur’s District Health Officer, Dr Mohsin Turabi, confirmed that his department took part in the sampling, and that affected workers and children were treated if lead was detected – a response he called a step toward a broader government policy to curb exposure, although he acknowledged children were harmed in the first place because safety protocols were never implemented.

Children pay the most

The health data from the UNICEF study reads as a cascade of compounding harms. Nearly 40% of the children tested were stunted, over a third underweight, and 55.7% were anaemic. These figures rise to 63–66% in Karachi and Lahore.

Children with detectable blood-lead levels had significantly higher rates of stunting, being underweight, and anaemia than those without. Behaviourally, 74% of exposed children showed hyperactivity, 71% frequent mood swings, and 68% regular tantrums. These patterns are consistent with the neurodevelopmental damage lead is known to cause.

But blood-lead testing itself remains a bottleneck. 

“Most primary, secondary and even tertiary care public-sector hospitals don’t have the facility for lead testing in their laboratory,” Dr Ammara Naeem said, warning that real surveillance would require major investment in lab equipment, trained phlebotomists and electronic reporting – infrastructure Pakistan largely lacks outside a single accredited national facility.

A plan, if it is enforced

Pakistan’s first Multi-Sectoral National Action Plan on Childhood Lead Poisoning has been developed as a result of the study. It is endorsed by federal and provincial stakeholders and built around a national steering committee, harmonised standards for paint, food and cosmetics, formal oversight of informal battery recycling, and integration of lead screening into routine child-health programmes.

“Lead poisoning is one of the most preventable threats to child health and development,” said Abdullah Fadil, director of the Partnership for a Lead-Free Future, whose mission to Pakistan coincided with the study’s launch, with a stated goal of eliminating childhood lead poisoning by 2040.

Whether that target is credible will depend on the same institutional weaknesses that have long stalled clean-air enforcement in Pakistan — chronic under-resourcing, poor federal-provincial coordination, and industries able to absorb fines more easily than they can afford filtration.

For now, in Hattar, Tariq Mehmood says villagers are still filing complaints with the  Environmental Protection Agency office that rarely seals a factory, breathing air that a UN agency has linked directly to the lead now circulating in their children’s blood.

Image Credits: Luis Arias/ Unsplash, WHO, IQ Air.

A baby in Niger shortly after being vaccinated.

In the face of dwindling health budgets, the World Health Organization’s (WHO) expert committee on immunisation has made several suggestions to enable countries to optimise existing vaccine supplies.

Countries can continue giving a single dose of the human papillomavirus (HPV) vaccine to girls aged 9-14 years to prevent cervical cancer – instead of two doses, the Strategic Advisory Group of Experts on Immunization (SAGE) advised.

This could enable resource-constrained countries to extend the vaccine to women aged up to 30 who have missed out, and routine vaccination to boys aged 9-14.

SAGE also recommends that countries can consider routine vaccination of girls aged 4-8 years with a single dose of HPV vaccine “if this is likely to result in increased vaccination uptake and coverage”.

“The global HPV vaccine coverage, at 33%, is far short of the global target we’re looking for, which is 90%,” SAGE chairperson Professor Anthony Scott told a media briefing on Tuesday.

“So, based on a review of updated evidence, SAGE decided the single dose schedule for girls aged 9 to 14 is now the most efficient approach to achieve this global target.”

SAGE chairperson Professor Anthony Scott

Diphtheria booster during outbreaks

Countries may also consider a single diphtheria vaccination during an outbreak, although SAGE cautions that this must be followed by routine immunisation. Children under a year usually get three doses of a diphtheria-tetanus-pertussis (DTP3) vaccine.

“[Diphtheria] outbreaks have been increasing globally, particularly in West Africa, South[ern] Africa, and the Eastern Mediterranean region. The outbreaks clearly reflect gaps in immunity caused by low vaccine coverage,” Scott explained.

SAGE also confirmed that a one-fifth fractional dose of yellow fever vaccine can be used in outbreaks for people aged two and older “when vaccine demand exceeds supply”.  

The same fractional dose can be used for preventive vaccination campaigns for people aged 2-59  “when vaccine supply, financial or other programme constraints would otherwise limit the timely implementation, scale or coverage of vaccination”, said Scott.

There should be no skimping on the polio vaccine, however. Countries giving fewer than three polio doses “should transition without delay to a three-dose infant schedule administered at 6, 10 and 14 weeks of age” and ensure 90% coverage.

However, fractional or full additional doses can supplement the three doses during outbreaks.

Gavi funding shortfall

SAGE executive secretary Professor Annelies Wilder-Smith

SAGE executive secretary Professor Annelies Wilder-Smith said that all SAGE’s policy decisions are “focused on optimising the use of existing vaccines to achieve the greatest possible public health impact amid growing financial constraints”.

“Immunisation programmes now more than ever must maximise the impact of available vaccines, while safeguarding equity and still protecting the most vulnerable,” she stressed.

The key driver of SAGE’s new recommendations is the funds shortfall facing Gavi, the global vaccine platform. Gavi supports immunisation in the world’s poorest countries with a gross national income per capita of $2,300 or less – and 56 countries qualify this year.

However, Gavi has only secured $9.3 billion of its recalibrated $10.2 billion strategic budget.

SAGE noted that currently available Gavi funding is “insufficient to maintain use of vaccines currently included in national immunisation programmes, which jeopardises country gains achieved to date and may undermine trust in vaccine programmes”.

Dr Kate O’Brien, WHO’s director of Immunisation, Vaccines and Biologicals, acknowledged that domestic and Gavi funding shortfalls will require countries to make “difficult prioritisation decisions”.

“Countries must be “supported to make evidence-informed decisions” through strong national immunisation technical advisory groups (NITAGs), to ensure that existing immunisation gains are protected, said O’Brien. 

“Against the funding constraints, SAGE has emphasised that maintaining vaccines already included in national programmes in GAVI eligible countries should be a top priority.”

Ebola and mpox

Dr Kate O’Brien, WHO’s director of Immunisation, Vaccines and Biologicals

SAGE welcomed the accelerated development of vaccines that target Ebola Bundibugyo Virus Disease (BVD), and the establishment of the “single protocol, adaptive platform design of the TUMAINI randomised controlled trial (RCT)”.

This platform will enable the efficient evaluation of two BVD-specific vaccine candidates (Oxford University’s ChAdOx1 BDBV and Moderna’s mRNA-1469), and Ervebo, a vaccine already licensed for Ebola Zaire.  

O’Brien said that the phase 1 trial for ChAdOx1 has been completed and a WHO technical advisory committee would be reviewing its data “in a short number of days or weeks”, and reviewing Moderna’s vaccine’s progress.

If the safety data is “sufficiently positive”, she expects the vaccines to move rapidly into phase 2 and phase 3 trials – possibly as early as the end of this month.

SAGE also recommended targeted mpox vaccination of people at risk of infection in communities affected by the virus, including children, people exposed through sexual networks, contacts of people with mpox and health workers with repeated exposure. 

“Preventive mpox vaccination may be considered in those at high risk of infection or severe disease, while preventive vaccination for children in endemic areas may only be considered within a research setting,” SAGE noted.

Image Credits: Gavi.

Pandemic risk is climbing to new highs as post-COVID reform momentum stalls, outpaced by accelerating climate pressures, declining health aid, and eroding public trust.
Pandemic risk is climbing to new highs as post-COVID reform momentum stalls, outpaced by accelerating climate pressures, declining health aid, and eroding public trust.

Escalating pandemic risks are outpacing international readiness as the Global Preparedness Monitoring Board (GPMB) completes its eight-year mandate. The board demands an urgent shift from technical fixes to sustained political commitment and independent oversight, laying out a five-pillar blueprint to translate technical evidence into intergovernmental action. 

BERLIN – A comprehensive review of global health reforms by the Global Preparedness Monitoring Board (GPMB) presented at the World Health Summit on Monday (12 October) reveals that nearly 70% of recommendations designed to safeguard the world have stalled or progressed too slowly.

The capstone report “Getting ahead of pandemic risk,” finds that out of 32 core recommendations issued by the independent panel since 2018, governments and international institutions have fully achieved only two. While 59 percent of technical implementation measures remain on track, 87% of political commitment initiatives have stalled – with pandemic risks increasing.

“The GPMB’s monitoring shows that the interconnected drivers of pandemic risk are actually intensifying,” warned Ibrahim Abubakar, professor of infectious disease epidemiology at University College London (UCL) and GPMB board member.

Co-convened by the World Health Organisation (WHO) and the World Bank Group, the independent board is co-chaired by Joy Phumaphi, former Minister of Health of Botswana, and Kolinda Grabar-Kitarović, former President of Croatia.

Key drivers accelerating global vulnerability include climate change, environmental degradation, and growing social mistrust, according to the report. To guide future global surveillance, the board outlined five foundational insights, emphasising political pathways, multisectoral One Health integration, continuous tracking across the risk continuum, artificial intelligence, and independent oversight.

Transitioning oversight to Health Assembly

From left to right: Gabriel Leung (moderator), Joy Phumaphi, Ibrahim Abubakar, Victor J. Dzau, and Ilona Kickbusch discuss the GPMB’s findings at the World Health Summit in Berlin.
From left to right: Gabriel Leung (moderator), Joy Phumaphi, Ibrahim Abubakar, Victor Dzau, and Ilona Kickbusch discuss the GPMB’s findings at the World Health Summit in Berlin.

Crucially, the report demands clear, reliable pathways into political leadership structures to ensure technical evidence translates directly into sustained accountability and decision-making moving forward. Key to this is the proposed global pandemic risk monitoring mechanism that is designed to be formally mandated and established by member states through the World Health Assembly (WHA), securing a direct reporting line to the UN General Assembly (UNGA).

Professor Joy Phumaphi, co-chair of the GPMB.
Professor Joy Phumaphi, co-chair of the GPMB.

To convert technical evidence into concrete political accountability, its assessments will feed directly into key intergovernmental governance structures, including the States Parties Committee for the Implementation of the International Health Regulations (IHR) and the future Conference of the Parties (COP) under the WHO Pandemic Agreement, the report’s authors note.

The framework will rank the overall severity of pandemic risks, establishing clear triggers where elevated risk levels mandate immediate political review, resource mobilisation, and collective international action. Beyond health governance, the mechanism will align its reporting cycles with broader political and economic bodies – such as the G20, BRICS+, African Union, ASEAN, the World Bank, and the IMF.

“Evidence alone is not enough,” said Phumaphi at the WHS event. “It must be anchored in the political processes that can generate action.”

Connecting political action to One Health

With over 70% of emerging infectious diseases originating in animals, ape sampling reflects the urgent need to intercept zoonotic spillovers before pandemics erupt.
With most emerging infectious diseases originating in wildlife, early animal sampling is vital to intercepting zoonotic spillovers before pandemics erupt.

Translating political commitment into effective prevention requires confronting where pandemic threats actually originate – at the interface of human, animal, and environmental systems. Yet, while over 70% of emerging infectious diseases originate in animals, the GPMB’s maturity audit reveals that 75% of its One Health recommendations and 90% of multisectoral engagement initiatives have stalled or progressed too slowly.

To close these governance gaps, the board calls for formally integrating non-health agencies – such as the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and the UN Environment Programme (UNEP) – into global monitoring structures alongside WHO.

However, global institutional reforms must align with frontline realities. For example, studies in Central Africa show top-down environmental restrictions fail because 78% of local forest communities rely directly on surrounding ecosystems for food and livelihoods.

“Mistrust has repeatedly emerged as a source of vulnerability affecting how people interpret information, how institutions work together, and how effectively societies respond during health emergencies,” said Phumaphi.

Public health leaders emphasise that establishing mutual trust between institutions and local communities is essential for long-term stewardship and sustainable spillover prevention. Future One Health monitoring must therefore maintain an independent analytical layer and total transparency to guarantee equitable access to data, tools, and medical countermeasures.

Integrating fragmented data across the risk continuum

Professor Ilona Kickbusch, GPMB board member.
Professor Ilona Kickbusch, GPMB board member.

To synthesise vast amounts of fragmented global data into actionable intelligence, the report calls for harnessing artificial intelligence and digital technology through a federated model.

Crucially, this digital network must track the complete pathway of risk – from upstream drivers and emerging threats through to political commitments, resources, implementation, and real-world impacts.

Tracking the full spectrum provides decision-makers with a dynamic picture of trajectory rather than static snapshots, revealing precisely where the chain from early warning to political action breaks down.

“This is not about building yet another parallel system in an already fragmented global health architecture,” underscored Professor Ilona Kickbusch, founder of the Geneva Global Health Centre and GPMB board member. “We want a connected system that connects what already exists.”

Overcoming the pandemic financing disconnect

Frontline Ebola responders in the DRC. The ongoing crisis underscores the urgent imperative to close the gap between global donor pledges and resources reaching the ground.
Frontline Ebola responders in the DRC. The ongoing crisis underscores the urgent imperative to close the gap between global donor pledges and resources reaching the ground.

Financing reforms remain among the most severely bottlenecked areas of global preparedness, with the GPMB report revealing that nearly three-quarters of its financial recommendations have stalled or progressed too slowly. The board identifies unpredictable political commitment as the primary barrier preventing high-level pledges from translating into sustained funding architecture.

This funding disconnect creates severe operational impairments on the ground during active crises, such as the Ebola outbreak in the Democratic Republic of Congo (DRC). Highlighting this gap during a WHS panel session on pandemic preparedness financing, Africa CDC Director-General Dr Jean Kaseya noted that while international donors reported disbursing $700 million, local authorities in the DRC were aware of only $160 million reaching the front lines.

To eliminate these blind spots, the GPMB stresses that future monitoring must track financing across the entire risk continuum – following funds from initial donor commitments down to actual resource allocation and frontline impact.

To bridge these gaps and break the historical “cycle of panic and neglect,” multilateral platforms like the World Bank-hosted Pandemic Fund, a core structural reform championed by the GPMB, use grant aid to leverage broader co-financing. Operating across 128 low- and middle-income countries, the fund yields a 1-to-7 catalytic effect, where every $1 in grant aid unlocks $4 from development banks and $3 in domestic co-financing.

While catalytic grants aim to maximise international aid, African nations are increasingly asserting financial ownership, with 28 countries recently mobilising over $130 million in domestic funds for continental outbreak responses.

Global health leaders have echoed the GPMB’s call to treat pandemic preparedness as an essential global public good, pointing to African-led frameworks like the Accra Reset and the Lusaka Agenda as the path to genuine health sovereignty and country-led coordination.

A sense of déjà vu

Professor Hajime Inoue cautions that today's pandemic warnings echo past unheeded lessons.
Professor Hajime Inoue cautions that today’s pandemic warnings echo past unheeded lessons.

Despite advancements, experts voiced mixed feelings regarding the panel’s recommendations, warning against repeating familiar cycles of complacency.

Pointing to earlier monitoring efforts, Hajime Inoue, professor at the International University of Health and Welfare in Japan, cautioned that nearly identical warnings followed the H5N1 avian influenza outbreak two decades ago and the West African Ebola crisis 10 years ago.

“Life is 5% planning and 95% implementation,” he said. “We are hearing this recommendation again because we failed to implement the recommendations that we heard before.”

Major political hurdles remain

Beyond implementation fatigue, political hurdles remain in intergovernmental negotiations, where member states must conclude the Pathogen Access and Benefit-Sharing (PABS) system before ratifying the broader WHO Pandemic Agreement, with the UN Political Declaration on Pandemic Prevention, Preparedness and Response providing crucial momentum to this process.

Taking the stage, WHO Director-General Dr Tedros Adhanom Ghebreyesus urged member states to convert high-level political momentum into legally binding commitments by swiftly concluding the pathogen access and benefit-sharing (PABS) annex.

Dr Tedros Adhanom Ghebreyesus thanks the board members for their work.
Dr Tedros Adhanom Ghebreyesus thanks the board members for their work.

“The world can only be better prepared when we implement all the initiatives,” said Tedros, thanking the board. “It should be everybody’s business to conclude this agreement, so the world is better prepared before the next pandemic.”

Establishing reliable pathways into political decision-making remains the critical test to ensure future warnings trigger immediate global action. As the GPMB’s original mandate concludes in December 2026, Tedros asked board members to extend their service voluntarily to guarantee a smooth transition while member states translate the panel’s blueprint into a permanent oversight structure.

See related story:

With Only Three ‘No’ Votes, UN Adopts Political Declaration on Pandemic Preparedness

Image Credits: Felix Sassmannshausen/WHS, GPMB Report, Felix Sassmannshausen, Wildlife Conservation Society Congo, X/Tedros Adhanom Ghebreyesus.