Newborn screening can prevent lifelong impairment, ensuring vulnerable infants receive early, critical medical care.
Newborn screening can prevent lifelong impairment, ensuring vulnerable infants receive early, critical medical care.

Universal newborn screening needs to be dramatically expanded to improve infant mortality, says the World Health Organization (WHO). Without intervention, many of the estimated eight million infants born worldwide annually with congenital anomalies face severe impairment or death, warns a new technical report.

The WHO report reflects a paradoxical landscape. As low- and middle-income countries (LMIC) successfully reduce deaths in infancy and early childhood by tackling the most deadly infectious disease, birth anomalies are now driving an increasing proportion of under-five mortality.

Between 2000 and 2023, the proportion of under-five deaths linked to birth defects surged from 1% to 4% in sub-Saharan Africa and from 3% to 11% in South Asia, according to new data. Globally, birth defects now account for almost 8% of all deaths among children under five.

“No child should miss the chance for a healthy future because a congenital condition was not detected early enough,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in a news release on Tuesday.

Systemic barriers obstruct lifesaving screening

WHO scientist Dr. Ayesha De Costa advocates for sustainable newborn screening
WHO scientist Dr. Ayesha De Costa advocates for sustainable newborn screening at a UN press briefing Tuesday.

High out-of-pocket costs and fragmented funding routinely exclude vulnerable infants from essential care. This is exacerbated as LMICs struggle to provide specialised medical care and long-term rehabilitation services that such children often require.

The new report also underlines that testing and diagnosis fail to save lives without a functional treatment pathway. Compounding this problem, inadequate emergency transport systems and severe workforce shortages frequently interrupt the continuum of care.

Without reliable data tracking systems to secure short- and long-term follow-up, early detection of treatable – and in some cases curable – conditions like sickle-cell disease, congenital hypothyroidism, and hearing loss often fails to lead to the treatment of vulnerable infants.

“Newborn screening is one of the best investments a country can make in the future of its children,” said Dr Ayesha De Costa, scientist at the WHO’s Department of Maternal, Newborn, Child and Adolescent Health and Ageing.

Sustainable state funding bridges care gap

To close these dangerous gaps, the WHO urges states to fully fund diagnostic initiatives, shielding impoverished families from catastrophic healthcare costs. For long-term sustainability, policymakers must shift from fragile donor-dependent models to tax-funded national insurance frameworks.

To begin this transition, the advisory proposes that health ministries of member states initiate targeted testing for at least one priority condition. Programmes can then expand incrementally as domestic infrastructural capacity grows.

When financially burdened governments adopt this pragmatic strategy, they can overcome initial limitations and establish effective care models. In India, for instance, a national screening programme reached well over 28 million children over three years, linking nearly 900,000 infants to treatment frameworks.

“Progress is possible even in resource-constrained settings when screening is linked to diagnosis, treatment, referral systems, and long-term care,” stated De Costa.

​​How Mentorship Is Quietly Transforming Maternal and Newborn Care in Sierra Leone

Image Credits: Photo by Visualss via Unsplash, Felix Sassmannshausen/HPW.

Ghana has combined the malaria vaccine with other proven tools, including using trusted voices to counter misinformation.

For decades, malaria has been one of Africa’s most persistent health challenges. In Ghana, it was once the leading cause of death for children under five. Bed nets and antimalarial drugs reduced deaths substantially, but by the mid-2010s, the pace of improvement had declined. 

Climate change was altering the length and intensity of transmission seasons. Resistance to the insecticides used on bed nets and to the drugs used to treat infection was spreading. The tools that had driven earlier progress were becoming less reliable. 

Then, between 2019 and 2024, under‑five malaria deaths fell by 86%. This did not happen by chance. 

With strong support from government, local leaders and technical partners, and a willingness to learn and adapt to changing needs, Ghana is showing that sustaining impact is possible.

Three things drove the decline in Ghana’s under-five malaria deaths: redesigning vaccine delivery around the needs of families in high-burden areas, activating trusted voices to counter misinformation at every level, and layering the vaccine with other proven tools rather than treating it as a standalone solution. 

Together, these approaches offer a practical model for how African countries can protect millions of children from malaria. However, across sub-Saharan Africa, progress against malaria is under threat as shrinking development budgets put life-saving programmes at risk.

Comprehensive prevention strategies 

Facing a high burden of malaria and backed by a strong pharmaco-vigilance system and robust immunisation systems, Ghana is showing what can be achieved. 

We joined the Malaria Vaccine Implementation Programme in April 2019, becoming one of the first three countries to pilot the vaccine together with Kenya and Malawi. The programme has since expanded across 11 regions in Ghana, protecting an estimated 4.8 million children.

Ghana’s results reflect the impact of combining vaccination with other proven tools, such as insecticide-treated bed nets, indoor residual spraying, and prompt diagnosis and treatment to reduce transmission and prevent deaths. 

Layering interventions protects children at multiple points – from preventing infection to reducing the severity of the disease and lowering the risk of death, especially in high-transmission settings where no single tool is enough. 

The original dosing schedule consisted of a three-dose primary series, followed by a fourth dose 18 months after the first dose, requiring additional facility visits beyond routine immunisation and wellness touchpoints. 

Many families in high-burden settings live far from primary health care centres, and many children missed the fourth dose because the system was not designed around the families it serves.

We addressed this by adjusting the malaria vaccination schedule to 6, 7, 9 and 18 months, aligning the fourth dose at 18 months alongside other Year 2 vaccines, including meningitis A and the second measles dose. 

In high-transmission districts, bed nets and vaccine boosters are also delivered at that same visit, maximising protection through a single point of contact. Co-delivery of interventions reduces the burden on families by limiting trips to health facilities, often located far away. 

It also helps health workers deliver more per contact, improving efficiency and reach. By designing primary healthcare services around families’ realities, Ghana is improving coverage and completion, especially for later doses, so more children receive maximum protection.

Trusted voices counter misinformation

Communities initially met the vaccine with curiosity and cautious optimism, alongside some hesitancy. We quickly learned that misinformation was a major challenge, and our early communications underestimated how fast rumours could spread on social media. 

Ghana Health Service (GHS) deployed teams to track and counter false and misleading narratives circulating across social and traditional media. 

At the same time, in-person feedback gathered in areas where the malaria vaccine is used provided valuable insights into community perceptions of the vaccine. Based on that information, the GHS then activated trusted voices to share clear and consistent information and address concerns directly.  

First, we trained frontline health workers to answer questions clearly and confidently during household visits and outreach sessions. 

Second, the GHS broadcast discussions on TV and radio in local languages, with live phone-in sessions that allowed community members to raise concerns and get immediate clarification from experts. In parallel, we trained radio talk show hosts and journalists to provide consistent, fact-based coverage and to invite health experts to debunk rumours live on air. 

Finally, we developed evidence-based infographics and other visual materials to counter misinformation and shared them widely across social media platforms. All this would not have been possible with a strong network that included community health workers, chiefs, religious leaders and civil society organisations.

As families began to notice fewer malaria hospitalisations and deaths, trust and demand steadily grew. This is when we expanded the anti-misinformation campaign nationwide, including in areas where rollout was phased, and reinforced confidence through robust safety monitoring with Ghana’s Food and Drugs Authority. 

The voices, channels and assets cultivated throughout the campaign played a crucial role in educating caregivers about the safety of the vaccine and countering rumours and misinformation. This effort has now been integrated into broader EPI communications activities. 

Political will and peer learning 

Sustaining progress will take political commitment and predictable financing. This is the core of the Accra Reset: African governments setting the agenda, prioritising proven tools and investing in the community workers who deliver them, with Gavi, the Global Fund and other donor mechanisms reinforcing country-led plans. 

This is no small undertaking, considering the competing priorities in health financing. Similarly, efforts such as the adoption of the Economic Community of West African States (ECOWAS) Regional Malaria Elimination Framework, which places malaria elimination at the top of regional health priorities, reflect that our leaders are committed to increasing domestic financing, strengthening accountability and supporting progress beyond donor funding.

Collaboration across countries is just as critical. Leaders should share successful delivery strategies, align supply chains and exchange lessons on community engagement and countering misinformation. 

With malaria vaccine rollout underway in more than 25 African countries, the experience exists. Now, let’s use it to move faster.

Ghana is committed to sustaining these achievements as we work toward full domestic immunisation financing by 2030. Our results show what is possible when evidence, partnerships, and community trust align. 

Every child in Africa deserves the opportunity to grow up free from the threat of malaria.

Dr Selorm A Kutsoati is a medical doctor and head of the Immunisation Programme at the Ghana Health Service. She currently leads Ghana’s malaria vaccine implementation effort, which has led Ghana’s malaria vaccine rollout since its inception in 2019.

 

 

 

Image Credits: WHO/Fanjan Combrink.

UNAIDS executive director Winnie Byanyima addressing a largely empty assembly hall at the opening of the UN High-Level Meeting on HIV/AIDS.

Despite remarkable advances against HIV over the past two decades, “let us not confuse progress with success”, warned UNAIDS head Winnie Byanyima at the start of the United Nations High-Level Meeting (HLM) on HIV in New York on Monday.

Over 40 million people are living with HIV, yet “almost nine million people are still not on treatment, and last year 1.2 million people were newly infected,” said Byanyima, her address delivered to a sea of empty chairs – symptomatic of waning interest in responding to the virus.

“This is our last High-Level Meeting before the 2030 promise to end AIDS as a public health threat. We are just four years away, and the opportunity is extraordinary.”

Africa is unhappy with political declaration

However, African countries expressed unhappiness with the political declaration due to be adopted at the end of the HLM on Tuesday. 

“The text renders the objective to end HIV and AIDS as a public threat by 2030 unachievable,” said Malawi Minister of Health Madalitso Baloyi, speaking on behalf of the continent.

“We are very disappointed with several areas in the text,” added Baloyi, listing the failure of the international community to “strengthen efforts for transfer of technology, equitable access to medicines and vaccines to developing countries”

Baloyi also highlighted the removal from the text “of a commitment to the supply of medical products,  including to countries facing unilateral coercive measures”.

Baloyi added: “The language on financing has regressed compared to the 2021 political declaration, reducing financing responsibility to mainly domestic financing and rejecting principles of equity and burden sharing.” 

Malawi’s Health Minister Madalitso Baloyi, speaking on behalf of the continent.

The European Union called for the political declaration to “serve as a pathway to accelerated and coordinated action, grounded in science, solidarity, accountability and human rights.”

The EU said that several requirements were needed to sustain the HIV response, including political will, strengthening synergies with co-infections such as tuberculosis and hepatitis; accelerated prevention, testing, and treatment, and country ownership with “stronger domestic financing”.

HIV is ‘the story of multilateralism’ 

President of the UN General Assembly, Annalena Baerbock told the HLM that “the story of HIV is a story of multilateralism itself”, and today, “reflecting the wider headwinds facing multilateralism, the HIV response stands at a crossroads again”.

“If we walk the last mile together, in the interest of all of us, we can end AIDS as a public threat. Or we can allow four decades of hard-won progress to be put at risk.”

UN Deputy General Secretary Amina Mohammed reminded the HLM of global achievements: “AIDS-related deaths have been reduced by 70% since their peak in 2004 and by 54% since 2010. HIV prevention and treatment services have reduced new infections by 40% in the same period, and today, more than 32 million people living with HIV are receiving lifesaving antiretroviral therapy.”

UN Deputy Secretary General Amina Mohammed.

She appealed to member states to “summon the political will to accelerate and finish the global HIV fight”, based on the UNAIDS Global AIDS Strategy 2026–2031, which centres “country ownership, people-centred services, and community leadership”.

In 2021, the UN adopted the  95-95-95 targets, which involve ensuring that 95% of people with HIV know their status; 95% of people with HIV are on antiretroviral (ARV) treatment, and 95% of those on ARVs are virally suppressed.

Aside from the 95-95-95 targets, UNAIDS also wants 90% of people in need of prevention to use prevention options, including lenacapavir, a twice-yearly injectable that offers almost total protection against infection.

Financial crisis

The HIV sector faces a massive loss of development aid, driven primarily by the United States, once by far the biggest HIV donor. It is winding down its President’s Emergency Plan for AIDS Relief (PEPFAR), largely substituting it with bilateral memorandums of understanding (MOUs) in terms of its American First Global Health Strategy. 

The HIV component of the US strategy is focused narrowly on preventing mother-to-child HIV infection.

South Africa, the country with the largest HIV population in the world, has not been invited to discuss an MOU with the US – and the US finally confirmed on the eve of the HLM that it intends to halt HIV support to South Africa due to political differences.

Zimbabwe, Zambia, and Ghana have also been unable to reach MOUs with the US.

The silver lining of the MOUs is the commitment by countries to incrementally increase domestic investment in their HIV response.

The UN has proposed “sunsetting” UNAIDS as part of the “UN80” cost-cutting in the face of a massive loss in funds. UNAIDS is fighting to remain, but as part of its transformation, it has already slashed staff by over 55%, including an 80% reduction in staff at its Geneva headquarters.

Meanwhile, HIV activists are campaigning for much broader access to the injectable lenacapavir, pressuring Gilead to allow generics and to reduce the price of the medicine.

President Surangel S Whipps (centre) and officials at the formal signing of the notification

The island country in the western Pacific Ocean has initiated a World Health Organization (WHO) review of nicotine in terms of the United Nations (UN) Convention on Psychotropic Substances

In 2023, I stood in a room among other Palauan mothers, school principals, teachers, and students who had come to witness the signing of Palau’s comprehensive prohibition on e-cigarettes, including their importation, distribution, sale, possession, and use. I told them I believed that if we let this industry continue unchecked, we would raise an entire generation damaged by vapes.

The prohibition was the right decision, but I knew even then how this works. The industry doesn’t stop. It continues to invent new products. We have already seen nicotine pouches appearing in Palau. Now we must develop new policies to regulate them, while, in the meantime, another generation becomes addicted.

Many of us in tobacco prevention and control have spent years focused on products – regulating what the industry sells. Yet the industry keeps creating new formats and flavors, all delivering the same addictive molecule, often targeted at young people. By the time regulation is in place, something new is already on the market. We are always one step behind.

What we see in Palau is not unique. It reflects a broader global pattern. According to our Ministry of Health and Human Services, more than half of Palau’s cancer cases are tobacco-related. 

Almost 46% of Palauan students aged 13 to 15 reported using e-cigarettes in a 2022 survey, before the prohibition of e-cigarettes in 2023. More than six in 10 of those who smoked said they wanted to stop but couldn’t. That is not a choice. That is an addiction. The addictive substance itself – nicotine – has been overlooked by the world’s regulatory systems for decades.

Review of nicotine

We realized we needed to rethink our approach. Instead of asking “Which product do we target next?” we should be asking: “Why has the molecule itself never been addressed?”

Cannabis, amphetamines, and ecstasy have been reviewed under international drug control. Yet nicotine – responsible for more than seven million deaths a year – has not. 

The molecule affects virtually every tissue and organ in the body. It damages the heart and lungs and disrupts brain development in adolescents and the unborn. Nicotine has an addictive potential comparable to cocaine and heroin. 

It drives addiction in over a billion people, most of whom began using it before they were old enough to make a choice. Globally, nine out of ten nicotine users start before the age of 18. Yet in decades of international drug control, not once had any country formally asked for a review of nicotine. 

On 10 June, Palau issued a formal notification to the UN under Article 2 of the 1971 Convention on Psychotropic Substances, requesting that the WHO Expert Committee on Drug Dependence (ECDD) conduct a critical review of nicotine. It is the first time any government has taken this step. 

Such a review will examine the evidence against the same criteria applied to every other substance on the drug control list: dependence potential, abuse risk, threat to public health, and therapeutic usefulness. We believe the evidence is clear—nicotine is a drug. It is time the world’s institutions treated it as one.

This step does not immediately change a single law in any country. It asks, formally and legally, for the first time, whether nicotine belongs under the same international framework that governs every other comparably dangerous and addictive substance.

While the mechanism has always existed, no government has used it until now. Palau invites others to follow.

Valerie Ngereblungt Remengesau Whipps, the First Lady of Palau, is a public health advocate and policy leader focused on tobacco control and preventing non-communicable disease (NCD). She chairs the Coalition for a Tobacco-Free Palau and serves on the country’s National Coordinating Mechanism for NCDs. 

 

Image Credits: Government of Palau.

EU lawmakers vote for lenient tobacco tax regulations in Strasbourg.
EU lawmakers failed to agree on tobacco tax regulations in Strasbourg this week.

The European Parliament on Wednesday defeated a proposal to freeze cigarette excise taxes at a 60% rate of retail value – throwing a final decision on tobacco and nicotine policies into the court of the European Council of Ministers. But the politically divided EU Council is unlikely to raises taxes anywhere near the bar set by the WHO’s latest recommendations for taxes on cigarettes, as well as novel nicotine and tobacco products that are surging in popularity.

A European Commission initiative, now set to go before the Council this summer, would raise cigarette excise taxes to 63% – still short of the WHO’s 70% benchmark. Meanwhile, excise taxes for e-cigarettes at low nicotine concentrations would be set at only 20%; at 40% for products with higher nicotine concentrations, and at 50% for nicotine pouches, according to the EC proposal. That’s in contrast to a WHO recommendation that excise taxes for all novel products be aligned with traditional cigarettes.

The requirement for unanimous European Council agreement on a tax package creates a major political hurdle for any initiative to raise cigarette to taxes and taxes on novel products further – in  alignment with WHO guidance. This, as the European Union records one of the world’s slowest declines in tobacco use.

The EU Commission initiative would also establish a stricter minimum tax floor of €215 per 1,000 cigarettes. The now-rejected European Parliament position had attempted to lower this floor to €200 per 1,000 cigarettes, while setting the proposed minimum excise tax on nicotine pouches to just 28% of the average retail selling price, a full 22% lower than the Commission’s original proposal.

EU tobacco tax misses WHO benchmark

WHO recommends that excise taxes – that is, taxes specific to products like tobacco and alcohol – account for at least 70% of a product’s retail price. Total taxes, including VAT and customs duties, should account for at least 75% of the retail price, according to the WHO recommendations.

Furthermore, the WHO has cautioned against differentiated taxation for novel products. Global health officials warn against creating such regulatory carve-outs, arguing that they sustain lifelong nicotine dependence.

Health advocates have meanwhile spoken out against revised tobacco taxes that make novel products highly affordable and easily accessible for young demographic groups.

Surging new products target youth

A recent WHO report highlights that retail sales of nicotine pouches surged past 23 billion units globally in 2024. Within the European Union, this market expansion is heavily driven by high consumption in Sweden, where novel pouches have become increasingly popular among young people.

WHO officials warn that these aggressively marketed products threaten to create an imminent youth addiction epidemic across the bloc if left unchecked. “The use of nicotine pouches is spreading rapidly, while regulation struggles to keep pace,” said Dr Vinayak Prasad, Unit Head of the Tobacco Free Initiative at the WHO, upon the release of the WHO global report.

According to health advocates, transnational tobacco companies are actively using Sweden’s experience to pressure other EU nations into adopting equally lenient regulatory and tax frameworks.

To attract adolescent consumers, manufacturers deploy digital influencer campaigns and candy-inspired flavours. Medical experts caution that some European brands feature extreme concentrations reaching up to 150 milligrams of nicotine per gram, significantly increasing cardiovascular risks and impairing adolescent brain development.

Divided Council to decide later this year

With the EU parliament failing to find a negotiating position, the burden now falls entirely on the EU’s Council of Ministers, including ministers from all 27 EU member states, to close the tax loopholes. The EU Council must now reach a consensus before adopting the final directive. The likelihood is that a tax increase of some kind will be approved, but it will be unlikely to even meet the level of the EU Commission’s proposal.  

The Swedish government, in particular, has been lobbying to keep tax levels low on alternative tobacco products due to its large pouch market.  Earlier this month, Sweden reportedly blocked an broad EU initiative that would have established a higher tax floor on novel products, sources told Health Policy Watch.

Nicotine Pouches: WHO Demands Strict Regulation to Prevent Looming Youth Epidemic

Image Credits: Felix Sassmannshausen/HPW.

Dr Faustin Ntirenganya (left) and surgeon trainee Dr Victoire Mukamitari.

Where a person is born should not determine whether they survive, whether they live with dignity, or whether they are forced to endure years of preventable suffering while waiting for surgical care that may never come.

Yet, across large parts of Africa, this remains the reality.

At this year’s 79th World Health Assembly (WHA79) in Geneva, world leaders gathered to discuss the future of global health, healthcare equity and international responsibility. Despite the scale of these conversations, one essential component of healthcare continues to receive far too little global attention: access to safe surgery in general, and plastic and reconstructive surgical care in particular.

For millions of patients, plastic and reconstructive surgery is not cosmetic. It is not optional. It is essential healthcare that restores function, mobility, independence and dignity.

It allows burn survivors to use their hands again. It enables children born with craniofacial malformations to attend school without stigma. It gives patients living with traumatic injuries, cancers or congenital defects the possibility of participating fully in life once more. These surgeries are lifesaving.

However, in many regions, access to plastic and reconstructive surgery is effectively denied.

Non-existent access to surgeons

For more than a decade, I was one of only two plastic and reconstructive surgeons serving Rwanda’s 14 million people. In some parts of the world, highly specialized surgeons are everywhere. In others, they are almost non-existent. When there is less than one trained surgeon for hundreds of thousands – or even millions – of people, the consequences are devastating.

In Rwanda, I regularly travel to hospitals where hundreds of patients arrive seeking care in a single day. Many have already waited years for surgery. Some live with severe burns that have left their limbs contracted and immobile. 

Others endure untreated injuries or tumors that continue to shape every aspect of their life. Some patients travel extraordinary distances only for us to tell them they must continue waiting because the system is already stretched beyond its limits.

What is most painful is knowing that many of these patients continue suffering or their conditions worsen to the point of becoming untreatable while waiting for care – not because treatment does not exist, but because access to trained specialists remains critically limited, there is too little infrastructure and too few resources available to meet the overwhelming demand.

Dr Faustin examines a 19-month-old child in rural Rwanda with a congenital tumour that will need a 10-12-hour operation to remove.

Sustained investment

Behind every surgical waiting list, there is a human life suspended in uncertainty. This is not merely a surgical issue; it is a global health issue. Healthcare systems cannot adequately

respond to trauma, burns, maternal health complications, cancer reconstruction or congenital conditions without sustained investment in surgical capacity.

And still, surgery continues to be treated in many international conversations as secondary rather than foundational to healthcare equity.

A documentary has been made about my team, which follows us as we work in remote hospitals in Rwanda and confront the daily realities of providing care within a system under immense strain. 

Our local work includes efforts to train the next generation of African surgeons, fighting to increase regional access to surgical care for the future.

Dr Victoire Mukamitari is a young surgical trainee navigating the immense pressures of training within a male-dominated field while carrying the hopes of becoming part of a new generation of plastic and reconstructive surgeons.

Dr Victoire Mukamitari is a young surgical trainee in Rwanda.

Unbearable pressure

There are days when the pressure feels unbearable. Days when electricity becomes unreliable in the operating room. Days when resources force impossible decisions. Days when a surgeon carries the knowledge that help arrived too late.

There is exhaustion, responsibility, grief and the emotional burden of carrying more patients than one healthcare system was ever designed to support.

But there is also extraordinary hope and immense pride to serve and contribute to something bigger than us.

Several years ago, I realized that no individual surgeon – no matter how committed – could ever meet this level of need alone. My response was to help build a training program capable of preparing the next generation of plastic and reconstructive surgeons across the region. 

My goal is to help train 30 new surgeons by 2030 so that no surgeon in Rwanda or neighboring regions will ever again have to carry this burden alone.

This mission is not about one doctor, one hospital or one documentary. It is about building sustainable healthcare systems capable of serving future generations with dignity and consistency, creating a multiplier effect.

And this work cannot happen through temporary interventions alone. It requires a holistic approach with long-term investment in surgical education, healthcare infrastructure, equipment, researchpartnerships and healthcare systems designed not only to respond to crisis, but to endure.

Most importantly, it requires the international community to finally recognize that access to surgical care is not optional within global health. It is essential, a fundamental human right.

The patients waiting for care deserve healthcare systems capable of treating them safely, compassionately and without years of preventable suffering.

The next generation of surgeons is ready to lead if the world is willing to invest in them. This should be a collective responsibility.

Dr Faustin Ntirenganya is a consultant, General and Onco-Plastic and Breast surgeon, at University Teaching Hospital of Kigali and Head of Department of Surgery at the School of Medicine and Pharmacy. The documentary, Making of a Surgeon: Fighting Africa’s Hidden Crisis, explores these realities and the growing effort to expand plastic and reconstructive surgical care across Africa. 

 

COP31 co-Presidents Türkiye and Australia used the Bonn climate talks to launch three flagship goals for November’s summit in Antalya. The targets chart a path to cut emissions from energy, buildings and waste, but steer clear of the fossil fuels and the finance fights that sank the last two COPs.

The stepping-stone meetings on the road to COP31 in Antalya unfolding in Bonn this week brought the first real clarity on what the incoming presidency wants the next UN climate summit to deliver on: electrification, reducing waste, and the energy efficiency of buildings and construction.

The three headline targets call for electricity to meet 35% of final energy demand by 2035, up from just over 20% today, a goal the presidency calls “35 by 35”. The second would halve the growth in global waste by the same date, and the third would cut the energy intensity of buildings by at least a quarter.

Together, they chart a course around sectors that are among the largest sources of global greenhouse gas emissions; the buildings sector alone accounts for around 37% of the global total.

As buildings, energy use and production and waste are also among the world’s leading contributors to air pollution that kills around 7 millon people annually, real reductions in emissions from the three sectors would also translate into near-term gains for health.  And progress on the targets would help reduce superpollutants, like methane and black carbon, that exacerbate warming as well as harming health. See related story:

Reducing Emissions of ‘Super Pollutants’ Would Slam Emergency Brake on Global Warming

But the agenda deliberately omits any reference to reducing or phasing out fossil-fuels in the process.  It is thus built to dodge the political torpedoes that sank the last two COPs, in Brazil and Azerbaijan.

The presidency has cast the package as the practical core of an “implementation COP”, echoing Brazil’s framing of COP30 a year ago.

“We need this COP to be a COP of implementation and acceleration,” said Chris Bowen, Australia’s climate minister and COP31’s president of negotiations, calling the agenda “an impressive blueprint to help us do that.”

Money missing from agenda

Low-carbon hospital in Alberton, South Africa, with solar energy, natural lighting, on-site grey water treatment and recycling – which opened in 2022.

Yet money — the other perennial battleground of recent UN climate summits, and the thing that makes any implementation possible — is also absent from the core agenda.

Beyond the three headline goals, the presidency’s ten-theme Action Agenda spans food security, oceans, green industrialisation, youth and education, and, of significant note for the health community, a pillar on resilient health systems.

The core targets, like the rest of the Action Agenda, are set by the presidency and are political objectives, not guaranteed outcomes. Countries must choose to take them up on their own in Antalya during formal negotiations to transform targets into binding commitments.

And the political momentum pushed by a presidency is not always enough to get a deal over the line. Hosting last year’s summit in the heart of the Amazon, a setting meant to put the critical role of rainforests in balancing the global climate at the centre of the talks, Brazil threw its weight behind a roadmap to halt and reverse deforestation, backed by more than 90 countries. It never made the final text, with over 100 nations declining to support the roadmaps Brazil’s presidency championed.

“What the world needs today is not another round of promises,” COP31 President-Designate Murat Kurum told delegates in Bonn. “It needs to see existing commitments delivered.”

1.5°C’s life or death moment

Planet on Course to Permanently Breach 1.5°C Limit by 2030

The new targets for Antalya land as the planet closes in on the 1.5°C limit UN climate negotiations are intended to defend.

While the presidency lists protecting that threshold in its official targets, the latest science shows the planet is on course to breach it permanently around 2030.

The electrification target is explicitly designed to hold the world on a 1.5°C path, based on International Renewable Energy Agency (IRENA) modelling. But with the fossil fuels behind roughly 70% of global emissions absent from the agenda, the presidency’s strategy looks more like pragmatic damage control than a course correction.

Human-caused warming reached 1.37°C last year, and global emissions hit a record 56.8 billion tonnes of CO2-equivalent in 2024, according to the annual Indicators of Global Climate Change report, published last week.

A separate analysis released in Bonn on Tuesday by Climate Analytics found that fossil fuel use must halve by 2035 to keep 1.5°C within reach. The growth in CO2 emissions has begun to slow, but emissions are still climbing, not falling.

“Fossil fuels are still pouring oil on the climate fire,” said Neil Grant, a senior mitigation expert at Climate Analytics. “We need to cut fossil fuel use sharply this decade, halve it by 2035, and drive it down to real zero by 2070.”

“The safer route is a rapid, planned phase-out of fossil fuels, powered by clean electrification,” said Bill Hare, the group’s chief executive.

The other key battleground of every COP since Paris – money – is not addressed in the presidency agenda either. A concept note circulated in Bonn unveiled a “Global Implementation Accelerator” and a “Climate Implementation Bridge” to speed climate solutions to the ground.

Both are coordination structures. Neither is a fund, and the presidency specifies that no new money is attached.

A target for an electric age

The COP31 Presidency’s target for electrification would reduce air pollution in cities, as well as climate emissions – but only if the electricity is produced sustainably.

The electrification goal draws on analysis from IRENA, whose latest roadmap finds electricity must rise from around 23% of final energy use today to 35% by 2035, and above 50% by 2050, to stay on a 1.5°C-compatible path.

The co-presidents frame the pitch as a move towards energy security as much as climate action. The protection renewables can offer from fossil fuel price shocks is drawing fresh attention as the war in the Middle East drives up oil and gas prices, forcing low- and middle-income countries to dig into their treasuries to afford the basic functions of government.

Electrification can be a hedge: cheaper, home-grown power that shields households, central banks and economies from volatile global markets and the geopolitical shocks that move them.

“The good news is that the answer to improved energy reliability and energy sovereignty is also the answer for emissions reduction – that is more electrification, more renewable energy, sovereign and reliable forms of energy, which is also cheap and is also the best for the climate,” Bowen said.

“Accelerating the energy transition will ease shocks to our energy systems, better protect our economies and households from high costs, and help keep bending the curve of emissions downwards,” he added, describing electrification as “the key to transitioning away from fossil fuels.”

But more electricity only cuts emissions if the power behind it is clean. While broadly welcoming the strategy, environmental groups warned it must be matched with investment in expanding renewables.

“More electricity alone is not the answer if it is still powered by coal, oil and gas,” said Fernanda de Carvalho, global climate and policy head at WWF. “Developing countries will also need finance and technology support to make this transition fair and effective.”

The targets released in Bonn do not specify how the extra electricity should be produced.

“Electrification can only deliver meaningful climate benefits if the power comes from renewables, not fossil fuels,” said Duygu Kutluay, a campaigner at Beyond Fossil Fuels.

Simon Stiell, the UN climate chief, who has thrown his weight behind the electrification push, urged delegates not to backslide.

“We don’t have time to re-open past debates or renegotiate commitments already made,” Stiell told the Bonn summit. “Tackling the global climate crisis is the hardest, but most important, thing humanity has ever tried to do together. It is worth doing, because we have no choice.”

What kind of waste?

Burning plastic e-waste to recuperate metal wiring: the COP 31 targets fail to address the generation of plastic waste upstream.

The second target takes aim at the climate impact of the world’s waste. The presidency wants to halve the growth in global waste by 2035, notably, not halve waste generation itself.

The world already generates around 2.1 billion tonnes of solid waste a year, a figure the UN Environment Programme (UNEP) projects will climb to 3.8 billion tonnes by 2050 in a business-as-usual scenario.

Mounting piles of trash and landfills are also a growing climate problem, with organic waste rotting in dumps one of the largest human sources of methane, a major accelerator of global warming.

Methane is responsible for nearly 30% of the rise in global temperatures since the Industrial Revolution. Food waste alone accounts for around 10% of global emissions, much of it as methane, a gas roughly 80 times more potent than carbon dioxide over the short term.

Yet because methane breaks down in the atmosphere within about 12 years, against centuries for carbon dioxide, cutting it is prized in climate diplomacy as a vital “emergency brake” on near-term warming. Reducing waste-related methane emissions, and along with that, waste incineration in low- and middle-income countries would also improve air quality directly and indirectly since methane is an important precursor of ground-level ozone.

What the presidency’s target actually means is also hard to define – particularly since the target makes no reference to a baseline year and does not specify what kinds of waste would be covered.

That ambiguity matters, as some waste streams, plastics above all, are politically explosive enough to derail a negotiation.

The missing piece: plastics

UN Plastics Treaty Talks Fail Again After Overnight Deadlock

While the target’s climate aspirations are positive, sidestepping plastics production could prove a gift to petrostates in the long run. A downstream focus on managing and recycling waste, rather than capping production, is exactly what petrostates fought to protect when global plastics treaty talks collapsed in Geneva last year.

A bloc led by Saudi Arabia, Russia and Iran, with the United States aligned, blocked any binding limit on production. More than 100 countries, unwilling to leave the upstream untouched, ultimately walked rather than accept a weak deal.

With less than a tenth of the world’s plastic recycled and production on track to triple by 2060, the same production-versus-waste-management fight could resurface at COP31.

The cause is also a signature of Türkiye’s first lady, Emine Erdoğan, who chairs the UN High-Level Advisory Board on Zero Waste, established by Secretary-General António Guterres in 2023 after a Türkiye-led resolution declared 30 March the International Day of Zero Waste.

A Zero Waste forum in Istanbul this month, organised by the foundation she heads, drew Guterres, UNEP chief Inger Andersen and Stiell, but produced no new commitments, even as it set up zero waste to be a central feature of the Antalya agenda.

The building target that quietly shrank

The third goal aims to reduce the energy intensity of the buildings sector by at least 25% by 2035.

Buildings and construction are heavyweight emitters, responsible for around 37% of global emissions and nearly half of all raw material extraction, from the sand, gravel and cement that go into concrete to the steel that frames it.

Roughly half the buildings that will stand in 2050 have yet to be built, most of them in fast-growing economies in Asia and Africa, according to UNEP.

How those millions of structures are built will lock in emissions for decades. A wave of poorly insulated, fossil-powered construction would commit the world to rising energy demand for the lifespan of every structure.

Despite the sector’s importance, the target was watered down hours after it landed, Climate Home News reported, another sign the presidency’s politically careful agenda may face serious headwinds once negotiations begin.

An initial presidency statement set a goal of a 25% increase in energy efficiency. A “small update” issued a day later swapped it for a 25% cut in energy consumption intensity. No reason was given.

The two metrics are not the same. Energy intensity measures the energy used per square metre, and can be brought down through superficial steps such as dimming lights or adjusting how a building is run, leaving structures untouched.

An efficiency target would force the costly structural work that delivers lasting cuts: insulation, heat pumps and retrofitted building envelopes. Recast as an intensity goal, the target can be met by operational tinkering while the deep renovations the sector needs are put off.

The fight the agenda leaves out

The shape of the COP31 agenda emerges as a pragmatic political choice to build the summit around problems less divisive than the fossil fuel and finance fights that tanked the last two COPs.

At COP30 in Belém last November, a bloc of petrostates led by Saudi Arabia drew more than half the nations present to its side and stripped every reference to fossil fuels from the final text, killing a phase-out roadmap that some 80 countries had backed.

Under the UN’s consensus rules, a single nation can veto language, even against majority support. With Saudi Arabia, Russia and the United States flanked by other major petrostates set to be in the room, any text dealing with fossil fuel phase-out will be dead on arrival.

The concession is a pragmatic but significant moment in the world’s fight against the climate crisis: the fossil fuels driving it are no longer seen as worth fighting over, a reality the joint presidency is conceding before talks begin.

That deadlock has forced the fossil fuel question to splinter off into a diplomatic track of its own. Frustrated by the inability of the core UN climate talks to move forward, 57 governments convened in Santa Marta, Colombia, in April for the first summit dedicated to phasing out oil, gas and coal, declaring the transition “past its point of no return.”

While the coalition’s power is limited, its creation signals a new shift in the phase-out fight. The Santa Marta countries account for about a fifth of global fossil fuel production, and include sizeable producers such as Norway, Canada, Australia, the United Kingdom, Brazil, Nigeria and host Colombia.

The world’s five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – stayed away from the talks.

For now, the higher-ambition camp is left to build toward a phase-out on its own, while the UN process moves on around it. The coalition will meet again in 2027 on the Pacific island of Tuvalu, co-hosted by Ireland.

The money that isn’t there

Achieving the presidency’s three targets, despite their limitations, would be a major achievement in the fight against the climate crisis.

But the question of who will pay to make them real, and how much – the defining fight of every COP in recent years as the world shifts from diplomatic documents to delivery – stands to derail the agenda altogether.

As of today, the world is paying a tiny fraction of the true costs of the three agenda items alone.

Meeting the electrification pathway requires global grid investment to roughly double, to about $1.2 trillion a year, IRENA estimates.

Investment in building energy efficiency must more than double to $5.9 trillion by 2030, according to UNEP’s Global Status Report for Buildings and Construction. The direct cost of managing the world’s waste, around $252 billion in 2020, is set to nearly double by mid-century, according to UNEP’s Global Waste Management Outlook.

The headline goal agreed at COP29 in Baku commits developed countries to mobilise “at least” $300 billion a year for the developing world by 2035, a figure the Global South denounced as a “betrayal”, alongside an aspirational, all-sources target of $1.3 trillion.

On the current trajectory, analysts estimate the flows covered by that goal will reach barely $427 billion a year by 2035, less than a third of the target.

Developing economies received around $196 billion in climate finance in 2023, with more than half of it arriving as loans rather than grants, deepening the debt of countries already crumbling under foreign repayment loads.

Even the institutions meant to deliver the “billions to trillions” now say it isn’t possible. World Bank President Ajay Banga has called the formula unrealistic, and the bank’s chief economist, Indermit Gill, has branded it a “fantasy.”

“Climate finance commitments to small island developing states are facing systemic collapse,” Anne Rasmussen, lead negotiator for the Alliance of Small Island States, told a Bonn press conference on Tuesday.

“Developed partners are defaulting on their legal obligations under the Paris Agreement, and key financial mechanisms are being crippled. SIDS are effectively being blocked from implementing vital climate priorities. It leads us to question whether the implementation of the NCQG is dead on arrival, unless these breaches of legal duty are immediately reversed.”

The presidency’s new instruments take no steps to close that gap. Kurum has described the Climate Implementation Bridge as a way to turn national climate plans into “investable project portfolios” and help finance reach the ground faster, not as a new source of cash.

A wider finance crisis

Global Health Leaders Urge Fewer Agencies Amid Funding Crisis

The shortfall is part of a wider crisis across the development aid world. Developing countries need an estimated $4.3 trillion a year to meet the Sustainable Development Goals, including $1.8 trillion for climate, according to UN Trade and Development.

The OECD warns the overall financing gap, having grown 60% to $4 trillion, could reach $6.4 trillion by 2030 without reform. This year’s Financing for Sustainable Development Report concluded the shortfall “risks reversing decades of progress.”

Climate is competing for that money with everything else falling short. Humanitarian appeals drew their lowest funding in a decade in 2025, while food programmes, global health budgets and the finances of the UN itself buckle under simultaneous cuts, led by the United States’ retreat from much of the aid system.

As at every COP before it, the fate of Antalya is likely to rest less on the ambition of its targets than on whether anyone agrees to pay for them.

“Public finance is not a preference for us, it is an oxygen for us,” said Isatu Kamara, climate finance coordinator for the Least Developed Countries group.

Image Credits: Netcare-Alberton Hospital, UNFCCC, https://www.netcare.co.za/News-Hub/Articles/environmental-sustainability-at-the-heart-of-new-hospital-design, Ernest Ojeh/ Unsplash, WHO,2021.

Africa CDC epidemiologist Dr Wessam Mankoula

The current Ebola Bundibugyo outbreak is three times larger than any other Ebola outbreak was four weeks after being declared a public health emergency, Africa CDC revealed at a media briefing on Thursday.

This Ebola outbreak was declared a public health emergency on 17 May, and there are currently 875 cases and 202 deaths, Africa CDC epidemiologist Dr Wessam Mankoula told the briefing.

The biggest Ebola outbreak in history, which affected West Africa and infected an estimated 28,600 people, had only registered 242 cases in four weeks – but that outbreak took almost three years to contain.

Ebola outbreak size at four weeks

Where’s the money?

Meanwhile, less than 10% of the money pledged to address the outbreak has been released to responders, Mankoula said.

On Tuesday, Burundi’s President Évariste Ndayishimiye, Chairperson of the African Union (AU), convened an emergency high-level meeting of African leaders, Africa CDC, the World Health Organization (WHO), Regional Economic Communities, partners and donors to accelerate the Ebola response in the Democratic Republic of the Congo (DRC) and Uganda.

The meeting mobilised $910 million in pledges, including $80 million from African member states.  However, only around $90 million of this has reached countries, which is hampering the response, Mankoula added.

The high-level meeting resolved to ensure that the full $518 million required for the joint continental preparedness and response plan is mobilised and disbursed within the next four weeks. 

The plan covers immediate response needs in affected areas and preparedness in at-risk countries, including surveillance, contact tracing, laboratory capacity, case management, infection prevention and control, risk communication, community engagement, logistics, medical countermeasures and cross-border coordination.

“The priority now is speed. Every pledge must translate into financing, supplies, people and support reaching the communities and responders on the ground,” said Dr Jean Kaseya, Director-General of Africa CDC.

Case fatality, contact tracing

The six key obstacles hampering the response.

Over the past week, there has been a 38% increase in cases in the DRC, with Ituri province still the heart of the outbreak, while North Kivu and South Kivu are also affected.

The case fatality rate (CFR) in the DRC is 23%, and nine treatment centres in the DRC’s Ituri province are over 90% full. 

There have been 67 recoveries in the DRC, while there have been seven recoveries in Uganda – which has only reported 19 cases and two deaths (a CFR of 10%), a figure that has remained stable for the past few weeks.

“Unfortunately, North Kivu, because of insecurity situation, is not accessible for most of the responders, and we are seeing a high case fatality rate coming from North Kivu, and also this is the lowest among the three provinces when we speak about the rate of the contact tracing,” said Mankoula.

Contact tracing is still lagging in the DRC, with around 6,000 listed contacts – whereas there should be 17,000 to 35,000 based on an estimated 20-40 contacts per patient.

Of the 6,000 contacts, around 4,000 have been traced – meaning that only around 15% of expected contacts have been identified and checked.

However, “testing capacity improved significantly”, said Mankoula, with almost no backlog in comparison to the five- to eight-day wait at the start of the outbreak.

Governments need to prioritise funding and support for midwifery to save the lives of women and babies

A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move?

When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. 

She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic.

Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most.

 This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking.

Preventable deaths

Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. 

Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost.

The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. 

Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. 

A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year.

These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations.

Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1.

There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. 

Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce.

For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond.

A midwife examines a pregnant woman in a rural community clinic in Guatemala.

For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. 

For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap.

With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment.

Yet despite all this hard evidence, investment is not being made at the scale required.

Midwives’ demands

This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence.

Their demands are clear and achievable:

 Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment.

Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system.

Commit to ICM Global Standards on education, pay, regulation, and leadership.
 Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away.

Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. 

The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time.

 That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it.

Investing in midwives is an investment in the future of every country that makes it.

Anna af Ugglas is chief executive of the International Confederation of Midwives.

Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa

Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health

Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health

 

Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives.

Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school.

A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once.

To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters.

The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt.

“Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.”

During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles.

“In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.”

Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea.

Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. 

Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms.

About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six.

“Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit.

“For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.”

Next generation data on climate and children

Percentage of children exposed to at least 3 climate hazards, per UNICEF data.

For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid.

The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution.

“The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.”

Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. 

The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion.

“Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.”

“They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.”

When the shocks overlap

Overview of the number of children exposed to climate-related hazards.

Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness.

A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease.

Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million.

“When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.”

One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade.

Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. 

Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation.

“These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.”

Global but unequal crisis

Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan.

In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates.

All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. 

In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. 

Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.”

“They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.”

“Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.”

Even moderate climate hazards can ‘put lives at risk’

On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible.

Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it.

“No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.”

That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger.

Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard.

Every child breathes air pollution

Areas exposed to air pollution around the world.

An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report.

The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. 

Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. 

Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world.

The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change.

Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said.

Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. 

Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift.

The cost of inaction

Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024.

Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering.

Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates.

Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute.

But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. 

At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. 

‘Not a warning of what is to come’

Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea.

Back in Papua New Guinea, Lorna still holds on to hope for the future.

“My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.”

“Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said.

UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last.

“This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.”

For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned.

“They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?”

“This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.”

Image Credits: UNICEF, UNICEF, UNICEF.