Doctors oversee newborn delivered at a Islamic Development Bank supported health facility in Banjab, Bamyan Province, Afghanistan. 

Last week marked five years since the Taliban stormed back to power in Afghanistan. The country’s women have seen their rights constricted from all sides – now, shrinking healthcare services and restrictions are making it difficult, sometimes impossible, for women to reach them.The past half decade of religious rule has seen women and girls barred from secondary and higher education, stripped of the right to leave their homes unaccompanied by men, or speak, sing, or read aloud in public.

December 2024 saw the Taliban close yet another door, forbidding women from engaging in medical and health education, leaving the country’s pipeline of future female doctors, nurses and midwives severely weakened.

The now guaranteed shortage of female health workers is compounded by restrictions on women being treated by male medical professionals, which is banned in multiple regions. Women are also banned from working in humanitarian agencies, raising the bar to access to care even higher.

UNICEF has warned that Afghanistan could lose up to 5,400 female healthcare workers by 2030 if restrictions on girls’ education and women’s employment continue. As many as 9,600 health workers could be lost by 2035, the agency said.

Afghan women often rely on female health professionals because of social expectations, gender segregation and restrictions on interactions between men and women. The presence of a female health worker makes it possible to speak openly about sensitive health problems – and can be the difference affecting whether many women seek care at all.

“With a male doctor, we cannot talk freely,” one woman receiving care from a female health worker in southeastern Ghazni province told Health Policy Watch. “With her, we can say everything.”

Maternity ward massacre

Smashed doors of the MSF facility in western Kabul following the assault.

After seven years of trying to have a child, Zinab Mohammadi travelled 240 kilometres from her home city of Bamiyan to the capital, Kabul, in May 2020. There, she gave birth to a boy at the Medecins Sans Frontieres (MSF) supported maternity wing of Dasthe-e-Barchi hospital in the west of the city.

She named him Omid, meaning “hope” in Dari. Moments after she gave birth, masked gunmen stormed the maternity ward and opened fire. Twenty-four people, including 16 mothers, an MSF midwife and two children, were killed. One gave birth to a healthy child in the middle of the terror attack.

Zainab survived, along with more than 100 people who escaped to safe rooms throughout the hospital. Her son Omid, less than half a day old, did not. “I had only four hours with my son,” she told Health Policy Watch.

MSF later said the massacre in the maternity wing had been deliberately targeted, although it could not establish with certainty who carried out the attack or why.

The assailants remain unidentified, and MSF withdrew from the maternity unit the following month, sayint it could no longer put staff at risk of renewed attack. The 55-bed facility had provided free specialist maternity care and assisted almost 16,000 deliveries in 2019.

Violence to crisis

Schoolgirls in Bamozai attend classes in 2007. Today, Afghan girls are not allowed to participate in education past the second grade.

The attack came fifteen months before the Taliban swept back into Kabul. Six years later, Mohammadi’s second maternity experience reflects how the dangers facing Afghanistan’s women have evolved under their rule.

Not an armed attack on a hospital, but the threats posed by a system in which distance, money, movement restrictions, a humanitarian funding crisis and dire shortage of female health workers stand in the way of women receiving care in time.

“Allah blessed me with a daughter last year,” Mohammadi said. “An elderly woman in our neighbourhood helped me a lot during the birth. But with many charity organisations gone and the Taliban’s restrictions on women’s freedom of movement, it has become extremely difficult for mothers like me to seek the care and support we need.”

For women like Mohammadi, the existence of equipped hospitals – while still scarce –  is no longer the only challenge. It is whether they can reach it, afford the journey and treatment, travel with a required mahram (male relative) and find an appropriately qualified female health workers when they arrive.

Already fragile system crumbles

A mother and her child in a WHO supported maternal care facility in Bajnab, Afghanistan.

Afghanistan’s health system was already fragile after decades of conflict, poverty and heavy dependence on international assistance. The funding crisis that intensified in 2025 has made that fragility more visible.

The World Health Organization (WHO) estimates that 14.4 million Afghans will require health assistance in 2026. Funding cuts are happening alongside food insecurity, disease outbreaks, climate shocks and large-scale returns from neighbouring countries.

Some 445 health facilities were suspended or closed during 2025, including 203 mobile health and nutrition teams, according to WHO data.

For remote communities, those mobile services were often the only practical connection to healthcare. Afghanistan’s maternal-health indicators have improved over the longer term, but the risks remain severe.

WHO and the Islamic Development Bank reported in May that the country’s maternal mortality ratio remains about 521 deaths per 100,000 live births, making Afghanistan one of the most dangerous countries on earth to give birth, with one woman dying every hour.

However, WHO says antenatal coverage has risen from 31% to 76% since 2007/08, while skilled birth attendance increased from 24% to 67%.

Health workers under pressure after ban on women

A Taliban humvee rolls through Kabul’s streets after the group took control of the country in 2021.

Maintaining those gains depends on a functioning health workforce. With the complete ban on women in the pipeline – currently 18% of specialised physicians and 29% of nurses are female – that workforce is under enormous pressure.

The slashing of female health workers comes as the country faces a shortage of 115,000 health workers to meet WHO targets for key health workers per capita. Meanwhile, women already working in healthcare face restrictions on how and where they work.

Shafiqa Salarzai, a female health workers in southeastern Ghazni province, travels more than 10 kilometres each day to reach women affected by the earthquake in neighbouring Paktika, providing counselling to those who lost homes, husbands and children.

“We listen to those who are traumatised,” Salarzai told Health Policy Watch. “They’ve lost everything.”

But such services are often dependent on humanitarian funding and temporary arrangements. When funding ends, the healthcare option can disappear with it. The restrictions also affect female health workers themselves.

A February 2026 report by UN Special Rapporteur Richard Bennett found that restrictions on movement, gender segregation and “mahram” requirements had severely restricted women’s access to healthcare.

Bennett documented cases in which women were denied or delayed emergency treatment because they lacked a male guardian. In one case, a woman was left to give birth outside a hospital.

The addiction treatment gap

A woman addicted to opium hides her face at a treatment centre in Mazar-i-Sharif.

Omid, the name Mohammadi gave her son, was also the name of one of the few places in Afghanistan where hope came in institutional form for the hundreds of thousands of people caught in the country’s addiction crisis.

The facility – one of the largest rehabilitation centres in the country housing up to 2,000 patients at a time – is a vital cog in Afghanistan’s fragile rehabilitation care system, functioning as a central detoxification and intake hub. The Pakistani Army’s attack devastated patients and doctors, exposing a widening care gap in a country where three to four million people are affected by substance use disorders and just one in 10 are able to access any form of structured treatment.

“This was not just a strike on a building,” said Dr Abaseen Mohammadi, a Kabul-based addiction specialist who had referred patients to the facility. “It has taken out one of the very few places in the country where people could receive structured treatment. We have nothing in the public sector to replace it.”

While details of the strike remain contested, what is less disputed is the critical role the Omid centre played in the country’s treatment landscape. Survivors and relatives describe a sudden loss of structure and support. Without follow-up care, many face a heightened risk of relapse in a context where community-based services are scarce and stigma remains high.

“I took my brother there because we had no other solution,” Farid, a Kabul resident whose sibling was among those killed, told Health Policy Watch. “He had stopped using for the first time in years. Now he is gone, and there is nowhere for others like him.”

The care gap laid bare by the strike on Omid has widened since 2021, when the collapse of the former Afghan government triggered a steep decline in international health funding. Much of the country’s healthcare system has been donor-financed, and cuts to development assistance have left services, including addiction treatment, struggling to operate at even minimal capacity.

“Substance use treatment is chronically underfunded, even where the need is enormous,” said an MSF regional officer. “When a facility like this is lost, there is no rapid replacement. The gap can persist for years.”

As Afghanistan enters the sixth year of Taliban rule, the country’s health crisis appears as an increasingly consequential legacy of their government – closed clinics, humanitarian organisations in retreat, services cut.

Yet the erasure of Afghanistan’s female health workforce of the future, and severe restrictions and women’s access to what remains of the country’s hospitals and clinics, may be the most lasting health legacy of all.

Image Credits: WHO EMRO, MSF, CC, WHO, CC, Jacksoncam.

Doctors lit a fire outside the Ebola Treatment Centre in Ituri province to protest delayed payment. As they put themselves at risk of Ebola by treating patients without pay, violence against health workers from local communities is mounting. 

Twelve Red Cross volunteers have been injured and an ambulance set on fire in 11 violent incidents during the 100 days since the Democratic Republic of Congo (DRC) declared its Ebola outbreak, the International Red Cross and Red Crescent Movement said Monday.

Three volunteers taking part in response activities were attacked and injured by a group of individuals in Beni, North Kivu province, on 19 August, according to the statement, issued jointly by the Red Cross societies of the DRC and Uganda, the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC).

“Attacks against volunteers and humanitarian personnel are unacceptable,” the Movement said, warning that every injured responder and damaged ambulance “reduces the capacity to provide emergency health and humanitarian services, putting more lives at risk and making the epidemic harder to contain.”

The deadliest Ebola outbreak for health workers, DRC’s 2018–2020 Ebola epidemic, saw more than 25 health workers killed in attacks over two years.

A day earlier, two volunteers were injured while attempting to conduct a safe and dignified burial – the practice of trained teams in protective gear burying the highly contagious remains of Ebola victims – in the village of Malikuti in Haut-Uélé province, and were evacuated to Isiro for medical care. This burial practice, while protecting communities from infection, denies families the chance to touch their lost loved ones, rites central to funerals in much of the region, making the restrictions a major source of anger toward response teams.

On 17 August, a Ugandan Red Cross convoy supporting the cross-border response was attacked in Aru, Ituri province, leaving one team member seriously injured and two ambulances pelted with stones and vandalised.

“These attacks serve as an alarming reminder of the risks faced by humanitarian workers and volunteers engaged in the fight against epidemics and emergencies,” the IFRC added. “Respect for humanitarian personnel and humanitarian activities is essential to ensuring that communities affected by epidemics and other crises continue to receive the assistance and services they urgently need.”

Attacks on health escalate

Each square represents a health worker infected by Ebola since the outbreak began in May. Over 40 have already died.

More than 260 attacks on health workers have been recorded in the DRC over the past six months, and eight health workers have been killed, UN Senior Ebola Coordinator Julien Harneis told reporters from Bunia on Friday.

“When we do respond, apart from the threat from the virus, healthcare workers and frontline workers have been attacked by youths, ambulances have been burned and stoned, and the healthcare facilities have been attacked,” Harneis said, “which is obviously terrifying because people are already risking their lives to deal with Ebola.”

Another 160 healthcare workers have been infected with Ebola, of which 43 have died. Many have not been fully paid for their life-endangering work as the health ministry and international community struggle to marshal funds to the response’s frontlines.

“Almost on a daily basis we face some kind of reaction from the communities,” Dr Thierno Baldé, the World Health Organization’s (WHO) incident manager for the response, said last week, a day after another ambulance was attacked. “These are difficult situations. People are having their relatives who are sick, who are dying.”

Attack on Ebola Hospital in Eastern Congo Echoes Past Violence Against Health Workers

Some 5,290 people have been infected, and 2,516 have died since the outbreak was declared on 15 May, according to health ministry figures published Friday.

The epidemic, driven by the Bundibugyo species of the virus for which no licensed vaccine or treatment exists, is the fastest-growing Ebola outbreak on record and the deadliest in the DRC’s history, with a case fatality rate of 47.6%.

Africa CDC warned last week that the outbreak may be three times its officially reported size, with only 30-40% of cases detected.

“The epidemic is spreading to an area that is bigger than France,” Harneis said. “And the outbreak is growing faster and wider than the Ebola response. And all of this is happening in an area that has ​had ​three decades of conflict and is generating huge humanitarian ​needs.”

Attacks on responders during the DRC’s 2018-2020 Ebola epidemic, previously the country’s deadliest, killed more than 25 health workers.

Image Credits: Anicet Kimonyo.

Indonesia's Health Minister Budi Gunadi Sadikin was nominated as candidate for the WHO DG election
Indonesia’s Health Minister Budi Gunadi Sadikin was nominated as candidate for the WHO DG election.

Indonesia has officially nominated its Health Minister, Budi Gunadi Sadikin, for the WHO Director-General election – in what is also an unconventional candidacy for the global health agency that has traditionally been led by medical or public health professionals. Sadikin was posted as an official nominee on the WHO election website over the weekend.

Sadikin was officially listed as prospective candidate over the weekend.
Sadikin was officially listed as prospective candidate on the WHO website over the weekend.

A nuclear physicist and banker by training, Sadikin took over the Indonesian Ministry of Health in December 2020, leading the country through the COVID-19 pandemic without any formal medical or public health background.

“And then suddenly the previous president put me [in charge] as the first health minister … to take care of COVID,” Sadikin remarked at an event on pandemic preparedness on the sidelines of the World Health Assembly.

Prior to his service as health minister, he built a corporate track record as the Chief Executive Officer of Indonesia’s largest Bank Mandiri, starting in 2013. He later served as Group CEO of the state-owned mining and aluminium enterprise PT Inalum until 2019.

Corporate leadership in a time of institutional crisis

Indonesia contributed some $30 million to WHO in voluntary funding last month to help close the outstanding funding gap.
Indonesia contributed some $30 million to WHO in voluntary funding last month to help close the outstanding funding gap.
WHO Director General Dr Tedros Adhanom Ghebreyesus shakes hand of Indonesian Health Minister outside WHO headquarters on 1 July 2026, after Indonesia pledged an additional $30 million to fund WHO.

Sadikin’s lack of medical or public health training is seen as a disadvantage by some observers. By contrast, all previous Director-Generals – with the sole exception of Dr Tedros Adhanom Ghebreyesus – were qualified medical doctors. Tedros holds an MSc in infectious diseases from the University of London.

However, Sadikin’s strong background in finance could arguably be a decisive advantage in the current climate.

As a key diplomatic credential, he is also one of the architects of the World Bank-hosted Pandemic Fund, launched in Bali in 2022.

While Tedros has not openly endorsed any DG candidate, he posted a flattering thanks to Sadikin on LinkedIn last month after Indonesia contributed some $30 million to WHO in voluntary funding to help close the outstanding funding gap in the agency’s 2026-27 $4.2 billion base programme budget. As of May, the budget remained short of $300 million in funding – even after its originally proposed 2026-27 base budget was pared back by over $1.1 billion since the United States withdrew from the global health agency in January 2025.

Fourth contender in the race

Sadikin’s nomination brings the current field to four declared contenders ahead of the 24 September deadline, along with Dr Hanan Balkhy of Saudi Arabia and Dr Hanan Mohammed Al-Kuwari of Qatar. Last week, Belgium’s Dr Hans Kluge announced his candidacy.

The declared candidates so far, also are informally regarded as the current “frontrunners” in the election, scheduled for May 2027 in Geneva. Just one month remains for new contenders or dark horses to emerge before nominations close on 24 September. 

The upcoming election comes at a time of tumult and change within the WHO. Funding shortfalls triggered by the United States’ withdrawal from the global health agency have forced far-reaching cost-cutting measures – reducing staff by 25% over the past year.

And over the past month, several members of the senior leadership team have left the organization – including the leading UK physician and researcher Dr Jeremy Farrar, whose departure was confirmed only last week. Farrar had also been considered a potential DG candidate but he has denied that he is running – however he has also remained mum on his future plans.  

Member States will elect the new leader during the 80th World Health Assembly. The successor will assume office on 16 August 2027, immediately after Dr Tedros Adhanom Ghebreyesus concludes his term.

See related story:

https://healthpolicy-watch.news/high-profile-departures-who-leadership/

Image Credits: Tedros Adhanom Ghebreyesus, Felix Sassmannshausen/HPW.

8th India Clean Air Summit in Bangalore, which ended Friday.

As Delhi’s officials finally take tough action on major pollution sources, the demand for a similar approach is rising in other states – as seen at the 8th Indian Clean Air Summit held this week in Bangalore. 

BANGALORE, INDIA – Two decades ago, authorities in Delhi switched public and heavy duty transport from largely diesel to compressed natural gas (CNG), then seen as a cleaner fossil fuel.

Electric bus in India
Like buses, light duty CNG trucks will now give way to EVs.

But on Thursday, Delhi officials blamed light-duty CNG trucks, the kind used in courier services or urban deliveries, as one of the persistent drivers behind Delhi’s notorious air pollution  – announcing a major initiative to phase out 150,000 CNG light duty trucks, as well as diesel vehicles. The ban on registration of new light-duty CNG vehicles is due to begin in January 2027 in the city extending to suburban areas in July. The move to phase out the trucks follows a policy of swapping out CNG passenger buses for electric ones, underway already for several years. 

“We’re transitioning to total clean fuel,” said Tarun Pithode, Member Secretary of the Commission for Air Quality Management in a press conference – referring to the switch to electric vehicles, in particular.

While CNG fuel is lower in particulate matter, “oxides of nitrogen (NOx) from CNG are leading to a lot of pollution, especially secondary particulate matter. The haze happens when NOx and ozone mix,” Pithode explained. 

Even if they meet current Indian emission standards, (Bharat Stage 6 – roughly equivalent to a Euro 6 vehicle), CNG light duty trucks emit more than 57 times PM2.5, while BS 6 diesel light trucks emit approximately 130 times more, officials said.

Light goods vehicles by fuel type across the Delhi region. Data source: Indian Commission for Air Quality Management

Demand rises for Delhi-like airshed approach

Neeraj Naryan and Sharlene Chichgar at the 8th India Clean Air Summit.

While Delhi’s airshed officials are finally taking significant steps, the demand for a similar airshed approach is rising in other states. That was the main message at the 8th India Clean Air Summit in Bangalore this week. 

Speaking at the event, Neeraj Narayan, a top pollution control official from the eastern Indian state of Bihar said, “the airshed methodology must be accepted by all.” 

Only a few of the 131 cities that were part of the 2019 National Clean Air Programme (NCAP) have so far achieved the targeted reductions in air pollution, pointed out Narayan, Member Secretary of Bihar’s Pollution Control Board. 

The programme aimed for a 40% reduction in PM10 particulate concentrations by 2025-2026, and/or meeting the Indian air quality standard of 60 micrograms of PM10 for one cubic meter of air (60 µg/m³). That is something only 23 out of the original cities attained, according to a 2026 progress review by the Center for Research on Energy and Clean Air.  And in fact, while data was tracked for 130 cities a larger pool of some 1,787 Indian cities persistently fail to attain Indian air quality standards, the CREA report stated.

Some 1,787 Indian cities fail to meet national national air quality standards.

“Do we have this much time?” he added. Bihar is one of India’s most polluted states.

Dr Ratish Menon.

Meanwhile, Dr Ratish Menon,  Narayan’s counterpart from Kerala, a coastal state considered an idyllic tourist destination, echoed his remarks. And much of the state’s air pollution comes from neighboring regions, he underlined. 

In the case of Kerala, “the larger chunk is sent from (neighbouring) Tamil Nadu,” Menon said, making the case for strategies to combat air pollution at the level of “airsheds” whose borders cross multiple states.

World Bank’s $750 million clean air initiative in India 

The call for an airshed approach was echoed by the World Bank representative, Sharlene Chichgar, at the conference. 

While the legal framework for the National Commission for Air Quality Management (CAQM) has been strengthened, it needs to have “much more enforcement powers,” she said.

In July, the World Bank announced a major finance initiative of $150 million to support Delhi’s new clean air measures, which included a major air pollution initiative in April, followed by a new $1.5 billion policy to promote  EV three-wheelers, cars and buses in July.   See related story: 

Can Delhi’s $2.5 Billion Shift to Electric and Low-Emission Vehicles Transform India’s Capital to a ‘Pollution Free City’?

That followed World Bank finance initiatives late last year of $300 million each for Uttar Pradesh and Haryana, two highly polluted states that border on, and in some places overlap with, the national capital region.  

The Uttar Pradesh programme will help 3.9 million households gain access to clean cooking and support a transition to clean transport by introducing 15,000 electric three-wheelers, and 500 electric buses in the cities of Lucknow, Kanpur, Varanasi, and Gorakhpur. The project also will support Uttar Pradesh state government plans to provide incentives to replace 13,500 polluting heavy-duty freight vehicles with lower emitting vehicles. 

The Haryana project will invest in air quality and emission monitoring systems to  better assess critical pollution sources. The project will also support investments in electric buses and three wheelers in the cities of Gurugram, Sonipat, and Faridabad, with better transport connections and job access – especially for women. The project will also support new no-burn technologies to manage agriculture waste management, and productive reuse of paddy stubble. Smoke from burning crop waste in Haryana and other neighboring states regularly cloaks the Delhi region in haze in the late autumn.  

Farmers burn stubble burning on 3 November 2025, at Tohana, Haryana.

While progress is being made, Chichgar called for a “stronger horizontal and vertical coordination of government” across departments and agencies, and between cities, states and the central government. 

She also emphasized the “need to work on data transparency, a lot in terms of how we share data with citizens, and also have more public awareness and audits on what is done on pollution, how is performing, and where the government needs to work harder.

“We need a committed executive, which puts a vision forward over the next 15, 20 years on air quality management… and puts in place the financing framework,” Chichgar said.

Air pollution politics

Air pollution has increasingly become a featured topic of conversation amongst  political and policy commentators and on social media along with other challenges of governance. One such recent post, for instance, highlighted the lack of government accountability for chronic air pollution along with other recent scandals including medical school entrance exam leaks, urban flooding, and corruption. 

Another columnist writing during last year’s peak winter pollution season, demanded a political debate on the Air Quality Index (AQI). 

Change is in the air  

Jai Asundi – sees progress in political prominence of air quality issues.

So has anything changed despite India dominating the world air quality rankings of the most polluted cities for years? 

The hosts of Indian Clean Air Summit, are well placed to assess that. The first Summit, which attracts a high-level group of scientists, researchers, entrepreneurs, policy experts and government officials, took place in 2018 just before India’s first National Clean Air Programme was launched.

Over the last eight years there has been a shift from treating air pollution primarily as an environmental issue to recognising it as a cross-sectoral development challenge, says Jai Asundi, Executive Director at the Center for the Study of Science, Technology and Policy. And that, he sees, is progress.

The fact that it is increasingly clubbed together with other political challenges doesn’t mean air pollution is being politicised, he said. In fact, what has changed most noticeably is the quality of the conversation reflecting a much higher level of greater knowledge. 

“Air pollution appearing in mainstream public discourse is therefore not necessarily a case of politicisation — it can also indicate that the issue has moved from a purely environmental sector concern to a broader public-policy and development concern. The next challenge is to convert that awareness and better evidence into sustained, measurable reductions in exposure.”

Image Credits: Chetan Bhattacharji/HPW, CAQM – Commission for air quality management, Centre for Research on Energy and Clean Air , Vidyut Mohan, Chetan Bhattacharji.

Health workers in the DRC put together protective gear during an Ebola outbreak in 2019.

Over 5,000 people have been infected with the Ebola Bundibugyo virus in the Democratic Republic of Congo (DRC), but the outbreak may be three times the officially reported size, warned the Africa Centre for Disease Control and Prevention has said.

Speaking at a press briefing, Africa CDC’s Prof Yap Boum said the estimation of various experts and academics, is that “only 30-40% of cases” are in fact being detected and reported.

Part of the reason is that the symptoms for Bundibugyo are milder than Ebola Zaire and “you don’t have the bleeding”, which makes it harder to distinguish from other illnesses, he added.

Boum also noted that the vast majority of deaths – 97% in the past week – were still taking place in the “community” – although he clarified that the definition includes health facilities that were not Ebola treatment centres.

Once again, the Africa CDC highlighted the weakness in contact tracing, with only around 16% of contacts with confirmed Ebola cases having been traced.

Spread to DRC regions near Central African Republic an emerging concern

Boum also sounded the alarm about new cases detected in the DRC provinces of Haut-Uélé and Bas-Uélé, which border the Central African Republic (CAR). Two cases have now been detected in the Bas-Uélé capital of Buta, about 200km from the CAR border.

Last week, the World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Africa CDC leaders met in CAR, which has also been wracked by years of conflict, to assist the country to prepare for Ebola in case it moved across the border.

Measures include increased surveillance at checkpoints and borders, and bolstering laboratories.

Ervebo vaccines to be trialled in DRC against Bundibugyo virus strain

Meanwhile, the DRC and international partners as preparing to conduct a clinical trial testing the efficacy of the Ervebo vaccine against the Zaire ebolavirus strain against Bundibugyo in amongst groups of health workers deemed to be at highest risk, WHO said on Thursday.

This followed an agreement with the International Coordinating Group on Vaccine Provision (ICG) to send 70,000 doses of Ervebo vaccines to the DRC, at the government’s. The ICG manages the vaccine stockpile in partnership with WHO, the International Federation of the Red Cross and Red Crescent, Médecins Sans Frontières and UNICEF. Gavi, the Vaccine Alliance, provides funding for the stockpile.

 

While Ervebo is only licensed and recommended for use against the Zaire ebolavirus strain, early laboratory and animal data suggest it may provide some protection, WHO said.

The allocation includes 20,000 doses for the Phase 3 of this trial, and 50,000 doses are for frontline health workers, in line with the current recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE).

Two other vaccine candidates, ChAdOx1, and Moderna’s mRNA vaccine, are currently recruiting patients in the DRC for early trials.

Image Credits: John Wessels/ MSF.

Hans Henri Kluge, the WHO/Europe Regional Director, at a meeting of WHO’s European Regional Committee (member states) in December 2025.

Dr Hans Henri Kluge, WHO’s Regional Director for Europe, has become the third candidate to throw his hat into the ring in the race for the next WHO Director-General. He will be taking a leave of absence from his duties from Friday, 21 August 2026 following his nomination by home country Belgium. This is according to an internal email by Dr Tedros Adhanom Ghebreyesus to WHO staff, seen by Health Policy Watch.

Kluge is also the second Regional Director, after Dr Hanan Balkhy, to temporarily step down from office under new guidelines issued by Tedros earlier in July.

The guidelines require WHO Regional Directors to step back from the posts and go on special leave at half pay if they enter the leadership campaign – despite the fact that RD’s are elected by member states. This rule aims to level the playing field with other internal WHO candidates who were already required to take leave in previous races.

Kluge had not responded to an earlier enquiry from Health Policy Watch regarding his possible candidacy. Tedros, however, made it clear in his message today:

“Dear colleagues, I am writing to inform you that Dr Hans Kluge, Regional Director for Europe, will take leave from his WHO functions effective 21 August 2026, in connection with his candidature for the position of Director-General of the World Health Organization,” the DG said in the internal mail sent just before 6 p.m. Thursday evening.

On Friday, Kluge confirmed his nomination in a LinkedIn post. “The Government of Belgium has nominated me for the position of WHO Director-General. I am deeply honoured by the trust and confidence Belgium has placed in me, and grateful for the opportunity to stand for this important responsibility,” the post read.

European Director of Programme Management takes charge

To ensure continuity in the European Region, Dr Corinne Capuano will take over as Officer-in-Charge on an interim basis, the WHO Director General added.

“I am grateful to Dr Capuano for assuming these responsibilities and confident that, with the support of colleagues across the Region and the Organisation, WHO’s vital work will continue without interruption,” said Tedros in the internal communication.

Capuano has been Director of Programme Management in Europe since February 2025.

Kluge, a Belgian physician, has led WHO’s European Region since February 2020 – through the COVID-19 pandemic, a subsequent mpox outbreak, and the cascading fallout of Russia’s war in Ukraine on health systems both in Ukraine and beyond.

The current field of candidates so far

Kluge’s declaration means that three candidates are now in the race. The other two candidates are listed as contenders on the organisation’s website are: Dr Hanan Mohammed Al-Kuwari (nominated by Qatar) and Dr Hanan Balkhy (nominated by Saudi Arabia).  But the list is expected to grow further before the final deadline for official nominations, set for 24 September. Indonesia’Minister of Health Budi Gunadi Sadikin is considered likely to enter the race.

Other figures around which speculation has centered have included Sania Nishtar, currently CEO of Gavi, The Vaccine Alliance and Helge Braun, a German physician and politician associated with the Christian Democratic Party – led for many years by former Chancellor Angela Merkel. Former French Health Minister Agnès Buzyn  has also been named as a possible candidate.

Several other high-profile figures whose names previously had been mentioned as potential candidates have recently said they would not run for the DG’s office. Dr Jarbas Barbosa, Regional Director of the Pan American Health Organisation (PAHO), ruled out standing for the race, saying that he wanted to focus on leading the Americas region, which faces its own financial troubles since funding from the United States, PAHO’s biggest donor, has become uncertain.  The noted British scientist Dr Jeremy Farrar, also has said he had “no intention” of standing for the top post – even though on Monday his resignation as Assistant Director-General Health Promotion, Disease Prevention and Care was abruptly confirmed by WHO, effective September.

While WHO claimed that Farrar, age 64, is retiring, several other sources claimed he had resigned – signaling potential dissatisfaction or a reluctance to continue being associated with Tedros’ administration in its waning days. Farrar has not publicly commented on his next moves.

Following the formal submission of DG nominations, the official timetable sets out two key dates prior to the final decision: the first candidates’ forum will begin on 18 November 2026, followed by the Executive Board narrowing the field of candidates down to a maximum of three finalists during its 160th session from 25 January to 2 February 2027.

The election by the Member States is due in May 2027 during the 80th World Health Assembly. The successor will take office on 16 August 2027, immediately after Tedros’s term ends.

See related story:

Want to Become the Next WHO Director-General? Get in Line 

Editorial note: The piece has been update on 21 August to reflect Kluge’s social media post.

Image Credits: WHO/Christopher Black , WHO/Europe .

 

Raymond Issa, a health surveillance assistant (HSA) under the Blantyre District Health Office (DHO), has been walking from house to house, giving al;l children under the age of 10 oral polio drops.

BLANTYRE, MALAWI – As early as 6:30 am, Malawi’s community health workers are already scattered across urban and rural neighbourhoods, dressed in sky-blue uniforms with square cooler boxes slung over their shoulders.

For four days in mid-August, health surveillance assistants (HSAs) across the country walked from door to door, administering the novel oral polio vaccine (nOPV2) to all children under the age of 10.

The cold weather and drizzle did not stop frontline health workers from carrying out their mission.

“I take pride in providing such lifesaving vaccines to children. It’s not really about the money, but the passion I have to contribute to public health,” said Raymond Issa, an HSA under the Blantyre District Health Office (DHO). 

Polio is a highly infectious disease that can cause permanent paralysis. There is no cure, but it can be prevented by vaccinations.

On the first day of the campaign, Issa visited 180 homes in three neighbourhoods, looking for children to give the polio drops to.

By 7.50 am on the second day of the campaign, Issa had already collected his ice packs and barely had time to talk to Health Policy Watch.

“My team members are already waiting for me,” he said, rushing off alongside a community mobiliser to resume vaccinations for the day.

This is the fourth mass campaign in Malawi. It is targeting children under 10 years old following the detection of a polio case in an unvaccinated seven-year-old child in Blantyre in December 2025. 

To interrupt any ongoing transmission, health workers are administering the oral vaccine in line with Global Polio Eradication Initiative (GPEI) guidelines for supplementary immunisation.

Mass supplementary campaigns aim to interrupt circulation of poliovirus by immunising every young child – in Malawi’s case, all under-10s – with two doses of oral polio vaccine, regardless of their previous immunisation status.

The drive builds on past responses, including a drive in February 2022 after Malawi recorded its first wild polio case (type 1) in 30 years, the first in Africa since the continent was declared free of wild polio in 2020.

Community mobilisation

Beatrice James, of M’bwana village, brought her six-year-old daughter to be vaccinated.

In M’bwana village, in the Chigalu Traditional Authority of rural Blantyre, Favour Divierious had already vaccinated 100 children by 9 am.

“The volunteer on our team did a great job mobilising communities. I managed to vaccinate many children because some mothers had organised them in one place,” said Divierious, who is also a HSA.

However, long distances present a persistent challenge. “This morning I have already walked eight kilometres. Sometimes I use a motorbike, but it is expensive because we usually do not receive allowances during the campaign.” 

As it is the school holidays, house-to-house distribution is necessary unlike during school time when health teams can administer doses directly in classrooms.

Beatrice James, of M’bwana village, was among those waiting to have her six-year-old daughter vaccinated.

“I first heard about this campaign from our community volunteer, though I didn’t know exactly when the HSA would arrive,” James said. “I was happy when she came. Even if there are a hundred immunisation rounds, I am ready for my child to receive every single one.”

Wastewater surveillance

Community health workers prepare the oral polio vaccine before heading out on foot to vaccinate children under the age of 10.

Blantyre is a high-risk focal point for transmission due to its dense urban population and ongoing mobility.

“Blantyre children are at a higher risk,” explains Myless Mhango, Blantyre coordinator of the Ministry of Health’s (MoH) Expanded Programme on Immunisation (EPI). “We have polio in circulation due to the recent case, alongside probable unvaccinated children returning from South Africa.”

To cover the district, Mhango’s office has deployed 622 three-person vaccination teams and 144 supervisors. Their target is to vaccinate 527,320 children by reaching out everywhere, including in the local markets.

“Ninety percent of the mobilisers are community volunteers who help address vaccine hesitancy,” Mhango notes. “Some parents hesitate because they do not understand why their children need multiple vaccine doses.”

Environmental surveillance has highlighted how easily the virus circulates through urban hubs.

Speaking at a high-level health briefing ahead of the fourth campaign, Dr Mike Chisema, the Ministry of Health (MoH) EPI programme manager, explained that wastewater monitoring had uncovered the virus. 

Initial samples isolated the virus in Blantyre treatment plants in late 2025, before subsequent testing detected it in Lilongwe.

“When you have conducted a campaign round and isolate another virus, it is considered a breakthrough infection,” he explained. “If you see it in Blantyre across three sites and then again in Lilongwe, it entails movement of the virus – circulation – with potential transmission risk if coverage is incomplete.”

To capture accurate transmission data, health teams are scaling up acute flaccid paralysis (AFP) surveillance alongside wastewater sampling, despite limited infrastructure. “Not all districts have sewage plants for environmental surveillance, making field tracking crucial,” Chisema said.

During previous nationwide rounds involving nearly 9,000 field teams and 2,000 supervisors, Malawi reached over 7.07 million children under 10. However, evaluations flagged localised coverage gaps in districts like Thyolo and Mulanje. “These gaps indicate ongoing risk because unvaccinated children remain,” he cautions.

Dr Mike Chisema, the Ministry of Health (MoH) EPI programme manager.

Multiple doses

Public health experts emphasise that multiple doses are essential to stop poliovirus mutation and achieve community-wide protection.

Speaking at the briefing, World Health Organization (WHO) Representative in Malawi, Dr Charles Njuguna, stressed that repeated vaccinations during outbreak responses are safe and necessary.

“Once strong population immunity is established, even children who are not fully vaccinated are protected by the vaccinated majority,” Njuguna said. “Until transmission is fully interrupted, every child everywhere must be reached. Polio anywhere is a threat to children everywhere.”

Dr Samuel Kondwani, GPEI Coordinator in MoH, highlights the ongoing risk despite progress. “Breakthrough cases have been detected within six months of previous efforts. There remains a lingering danger of importations,” he warns.

Because of persistent operational hurdles globally, the Global Polio Eradication Initiative (GPEI) Strategy 2022–2026 timeline has been extended to 2029 to ensure countries have adequate time to close immunity gaps.

Regulation planned to stop vaccine hesitancy

Pockets of ‘zero-dose’ children, those who have never received a single routine vaccine, remain a major barrier, largely driven by religious opposition to modern medicine.

“Religious hesitancy is a very serious issue contributing to zero-dose children,” said Mhango. “The child who contracted polio in Blantyre last December had never received any vaccine since birth. Unvaccinated children place all other children at risk.”

To address persistent refusals, the MoH is backing a major legislative overhaul. 

Malawi’s Secretary for Health, Dr Dan Namalika, said that the government aims to resolve religious opposition through a revised Public Health Act, which is scheduled for parliamentary debate soon.

The proposed law would mandate emergency child immunisations, providing legal grounds to intervene when parental refusal creates public health risks.

“We are obliged to protect every child through immunisation,” he emphasised. “We don’t need a hundred or a thousand cases to declare an outbreak.”

Anthony Masamba, MP, chair of the Parliamentary Committee on Health, confirmed that revisions to the Act are entering final stages.

“This Bill is addressing many issues,” Masamba told Health Policy Watch. “It includes mandatory immunisations for those who deny their children protection while endangering others.”

Supported by the WHO, UNICEF, Gavi, Rotary International, and the GPEI, among others, Malawi’s health workers remain focused on delivering the supplementary round, working door to door to protect every child and choke out poliovirus transmission permanently.

Regional successes

Meanwhile, Malawi can take heart from the fact that five African countries – Burundi, Ghana, Guinea-Bissau, Republic of Congo, and Uganda – have officially stopped the spread of their poliovirus type 2 outbreaks.

The announcement was made on Thursday by the World Health Organization’s (WHO) Africa region, which had deployed teams from the Independent Outbreak Response Assessment (OBRA) to review the five countries’ disease surveillance, laboratory and epidemiological data. 

“These outbreak closures demonstrate what can be achieved through strong national leadership, dedicated health workers and close collaboration between governments, communities and partners,” said Dr Mohamed Janabi, WHO Regional Director for Africa. 

“While this is an important milestone, it is not the end of the journey. Continued vigilance, strong surveillance and high immunisation coverage remain essential to protect children and prevent future outbreaks.” 

The WHO warned that there is still a risk of the poliovirus being reimported, as demonstrated by the recent poliovirus detection in Madagascar, following its previous outbreak closure.

This underscores the need to sustain high-quality surveillance and strong population immunity”, WHO Africa stressed. 

Image Credits: Josephine Chinele.

A five-year study tracking more than 3,400 children provides the first evidence that a clean air zone can reverse pollution damage to developing lungs, vindicating London’s controversial vehicle restrictions.

The lung capacity of thousands of children stunted by traffic fumes on London’s streets recovered fully in the five years after the city imposed limits on its most polluting vehicles, a landmark study has found.

The research, published Tuesday in The Lancet Public Health, tracked more than 3,400 children in London and Luton, a commuter town north of the capital, from before the Ultra Low Emission Zone (ULEZ) took effect in 2019, providing what its authors describe as the most definitive evidence to date that a clean air zone can improve lung growth in children.

No previous study had addressed the question, researchers said, calling their results “the first evidence that air quality improvements following introduction of a clean air zone are associated with improved lung growth trajectories in children” across a literature review spanning back to the year after the dust settled from World War II in 1946. 

“Traffic pollution in cities damages children’s health and development,” said Chris Griffiths, professor of primary care at the University of Oxford and Queen Mary University of London and joint senior author. “We provide the strongest evidence yet on how these harms can be prevented. Ambitious clean air zones should be considered a priority for cities globally with traffic-related air pollution.”

Graph shows roadside NO₂ across London, annual mean in µg/m³. The shaded band shows the pollution the ULEZ removed, with roadside NO₂ more than halved since 2016. Despite the drastic improvement, emissions levels remain over WHO’s guidelines.

The ULEZ, which charges drivers of older, more polluting vehicles £12.50 per day to circulate inside its perimeter, was introduced in central London in April 2019 and expanded to cover the entire city by August 2023, making it the world’s largest clean air zone.

When London mayor Sadiq Khan, who was diagnosed with adult-onset asthma at 43 after training for the 2014 London Marathon on the city’s polluted roads, launched the zone’s first phase, he was attacked by politicians and voters across the aisle, cast as having “declared war on drivers in blind pursuit of a policy that may not even work,” he wrote in the Guardian in an op-ed accompanying the study’s release.

“For years, politicians and pundits opposed to the Ulez have cynically sought to turn questions of public health into a crude culture war,” Khan wrote. “All the mainstream political parties, including my own, were opposed. In recent years, though, those critics have gone quiet.”

“Today, though, it’s clear that we’re winning the battle against toxic air in the capital, and it’s London’s children who are reaping the rewards.”

Impaired lungs down by a third as London children ‘catch up’

Oxford Street, once one of Europe’s most polluted shopping streets, already bans private cars during the day and is due to go fully pedestrian by late 2026, with all traffic including buses and taxis removed from its central stretch.

The study recruited 1,664 children in London and 1,750 in Luton between June 2018 and April 2019, all aged six to nine, from 84 primary schools. Luton, a town 32 miles northwest of London with a similar pollutant mix and demographic profile but no clean air zone, served as the control site, with researchers measuring lung function at annual school visits in both cities.

Before the ULEZ took effect, children in London had significantly smaller lungs than their peers in Luton, and were breathing more than double the levels of nitrogen dioxide, the pollutant most closely tied to vehicle exhaust.

Children are especially vulnerable to the toxic effects of dirty air. They breathe faster than adults and more often through their mouths, their heads sit closer to exhaust pipes, and their still-developing lungs absorb lasting damage from long-term exposure, raising their risk of asthma, chronic obstructive pulmonary disease, heart disease, diabetes and premature death well into adulthood.

Over the five years since the low emission zone’s introduction, London children’s exposure to NO₂ fell twice as fast and more than twice as much as in Luton.

As the haze of exhaust from ageing diesel cars, trucks and London’s ageing buses thinned, children’s lung growth accelerated by nearly 5% per year over the comparison group, closing the gap entirely. By the study’s end, lung capacity in the two cities had reached parity. London’s children had caught up.

Graph shows lung-capacity gap between London and Luton children over time. London’s children started the study with smaller lungs. Four years later, the deficit was gone.

The share of London children with clinically impaired lung function, damage severe enough to cause coughing and breathlessness, fell by more than a third over the study period, dropping from 14% to 9%. In Luton, where only smaller-scale air quality measures were underway, the decline was 2%.

“We already knew that the ULEZ reduced air pollution, but now we know that children’s lung health has improved at the same time, which is a really important finding for children and parents living in London,” said Helen Wood, research fellow at Queen Mary and the study’s lead author.

Complementary research by Imperial College London published in June found reducing air pollution lowers premature deaths across the board, not just in children. Premature deaths linked to air pollution in the capital fell by roughly 40% between 2019 and 2024 as the ULEZ expanded, researchers found, with emergency cardiac hospital admissions falling 9.3% and overall admissions dropping 5.1%.

Deaths attributable to air pollution fell from an estimated 6,400-8,000 in 2019 to 3,800-5,100 in 2024, while London met legal limits for nitrogen dioxide for the first time in 2024, Imperial’s study found. 

London hit its legal air quality target 184 years ahead of forecasts, leading the number of deaths attributed to toxic air falling by about 40% in five years.

“If we want to improve the lives of children living in high-traffic urban environments, we need bold and ambitious measures,” said Ian Mudway, associate professor in the School of Public Health at Imperial College London and joint senior author. “Our data demonstrates that clean air zones can be an effective public health intervention to prevent damage to developing lungs.”

Together, the growing collection of studies and data in London trace a clear story: air pollution was damaging children’s lungs, a policy was introduced to cut it, the air got cleaner, and both children’s lung growth and adult survival rates improved.

Before the ULEZ, researchers at King’s College London had calculated that at the pace air quality was then improving, the city would take nearly two centuries to bring NO₂ within legal limits. The zone got there 184 years ahead of schedule.

“We must not be complacent,” Wood added. “Air pollution in both London and Luton, as well as other cities across the UK, remains above WHO guideline levels, so there is still work to be done.”

Nearly the entire global population lives above those guideline levels, which the WHO tightened in 2021 in recognition of evidence that no level of air pollution is safe to breathe. Dirty air is linked to more than eight million deaths per year, according to the State of Global Air, making it the second leading risk factor for death worldwide.

A decade of evidence

The findings cap a research arc stretching back more than a decade. A predecessor study by the same Queen Mary team, known as EXHALE and published in The Lancet Public Health in 2019, had established that London children exposed to higher levels of traffic-related NO₂ had measurably smaller lungs, with those in the most polluted areas showing 5-10% less lung capacity than peers elsewhere.

London’s original Low Emission Zone, rolled out from 2008, had produced only small improvements in air quality, and EXHALE found no evidence those gains were reaching children’s lungs. The zone’s modest progress, researchers found, showed “no evidence of a reduction in the proportion of children with small lungs” despite the cleaner air.

“Interventions that deliver larger reductions in emissions might yield improvements in children’s health,” researchers wrote at the time.

The verdict, however, came with a caveat. EXHALE measured a different group of 8-9 year-olds each year, a series of snapshots that could reveal the damage but never followed any single child long enough to know whether it could heal. 

With ULEZ’s announcement, the team saw an opportunity – the new policy offered the chance to run a stronger experiment by recruiting a single group of children in the year before the zone launched and measuring the same lungs annually as the policy took hold. That study became CHILL, the Children’s Health in London and Luton study published this week.

A statue of Ella stands in Southeast London’s Mountsfield Park, commemorating her passing and place as the first person to have air pollution attributed as the official cause of death.

In a city of 12 million people, the science was only part of the story. In 2013, nine-year-old Ella Adoo-Kissi-Debrah, who lived 25 metres from the South Circular Road, one of London’s busiest and most heavily congested arterial routes, died following a severe asthma attack after 27 hospital admissions in three years.

A landmark 2020 coroner’s ruling found air pollution made a “material contribution” to her death, making her the first person in the world to have it listed as a cause of death.

Her story became the clarion call for local action, with grassroots groups of parents, teachers and doctors springing up across London to make public demands for action on air quality heard.

Mums for Lungs, founded in Brixton in 2017 by parents alarmed that their borough exceeded annual safe pollution limits within the first days of each year, campaigned for the ULEZ expansion, drove diesel surcharges in Lambeth and won School Streets closures around pick-up and drop-off times that cut NO₂ by up to 23%.

“This shows that cutting air pollution doesn’t just help Londoners being born today,” Khan wrote. “It can help children whose lungs have already been stunted by toxic air to recover, proving that it’s never too late to act.”

More than 325 low-emission zones now operate across Europe, from Germany and Italy to France, Belgium, Spain and the Netherlands, with over 500 planned on the continent.

Yet the scientific evidence for the health and economic benefits they provide has lagged far behind their spread, leaving leaders like Khan to fight bruising political battles over congestion charges, scrappage costs and the burden on lower-income drivers armed with little more than the intuition that cleaner air must be healthier.

Slowly, that research is starting to catch up. A study comparing Belgian cities with and without clean air zones, published last year, found that the zones in Antwerp and Brussels accelerated declines in all major pollutants and reduced socioeconomic disparities in exposure.

In Madrid, the low-emission zone’s introduction in 2018 has been linked to improvements in both air quality and student academic performance. A 2023 systematic review in The Lancet Public Health found the strongest evidence for cardiovascular benefits, linking the zones to fewer hospital admissions for heart problems and stroke.

The cost of clean air

Sub-Saharan Africa’s annual air quality funding from governments and development finance institutions buys about eighteen of London’s buses.

Even as the science strengthens, a formidable hurdle stands before cities hoping to follow London’s lead: the price tag.

The city’s entire bus fleet was retrofitted or replaced – part of an ongoing multi-billion pound effort to create a fully net zero fleet – growing London’s zero-emission fleet from just 30 buses in 2016 to more than 3,000 today, one of the largest in Europe. 

The vehicle scrappage scheme, providing subsidies for people to replace polluting vehicles no longer allowed under ULEZ rules, alone cost  £160 million. A further £33 million has flowed through the Mayor’s Air Quality Fund to more than 100 local projects since its launch.

Few cities outside Europe and North America can hope to match that investment. Sub-Saharan Africa received less than 1% of global outdoor air quality funding from governments and development finance institutions in 2023, a total of $12 million for the entire region. That’s less than a tenth of what London spent on its scrappage scheme alone, and less than the city spends in a single year operating its reference-grade air monitoring stations. Air pollution killed an estimated 1.2 million people across the continent in 2021.

To add pollution to inequality, successful ULEZ schemes and broader vehicle emissions standards at national and European levels actually fuel the import of air pollution into developing cities.

A UN Environment Programme report found that 14 million used vehicles were exported from wealthy nations to developing countries between 2015 and 2018, more than half to Africa, with up to 80% failing to meet minimum emissions standards.

“Over the years, developed countries have increasingly exported their used vehicles to developing countries,” Inger Andersen, executive director of the UN Environment Programme, said of the study. “Because this largely happens unregulated, this has become the export of polluting vehicles.”

Some cities are trying. Jakarta is electrifying its bus fleet and building the evidence base for a low-emission zone of its own, while Accra and Nairobi have established their first air quality monitoring networks.

Yet for most of the world, following London’s path will be neither quick nor cheap. What changed this week is that cities around the world now have evidence to show a vital point: low-emission zones work. 

Image Credits: Aron Van de Pol, Ashleigh Joy, CC.

A patient and her baby consult a nurse in a health facility in Sierra Leone. The Safe Motherhood Bill aims to improve sexual and reproductive health services.

FREETOWN, Sierra Leone – For nearly two years, Sierra Leone’s Safe Motherhood and Reproductive Health Care Bill has been stuck in a political and social tug-of-war that has little to do with the technical business of passing a health law. 

Instead, the country is wrestling with who gets to define reproductive health in the country: Parliament, doctors, women, religious leaders, families, and so on. 

The Bill was introduced in Parliament on 17 December 2024, with the stated aim of introducing “safe motherhood and reproductive health care throughout Sierra Leone, to set the standards for reproductive health care, [and] to provide for the right to make decisions regarding safe motherhood and reproductive health”.

Health Minister Dr Austin Demby motivated the reforms, saying that 82% of illegal abortions resulted in complications and teenagers accounted for a significant proportion of maternal deaths.  Demby also advocated for better support for pregnant schoolgirls and greater choice about unwanted pregnancies.

But the Bill was met with an immediate outcry from religious leaders. The Speaker then referred it to Parliament’s Legislative Committee for further consultation. 

At a stakeholder meeting hosted by President Julius Maada Bio in January 2025, the President conceded that his Cabinet had approved the legislation but called for Parliament to engage more with religious and other parties. 

By March 2025, Parliament noted simply in relation to the Bill: “Further consultation to be held.” 

Over a year later, in July 2026, civil society groups, health professionals, and MPs are still asking Parliament to fast-track it. The Bill is being kept alive, but it is not allowed to move.

Conservatives woo First Lady

Sierra Leone Health, Dr Austin Demby and Chargé d’Affaires Rabia M Qureshi, of the US Embassy in Freetown display the newly signed bilateral health agreement.

The political climate surrounding the Bill has become more complicated by the staunchly anti-abortion Trump administration resuming control of the United States government in January 2025. 

In late December 2025, Sierra Leone and the Trump administration signed a bilateral aid agreement in terms of the America First Global Health Strategy. The US will contribute $129 million to assist the country’s various health concerns while Sierra Leone will invest $44 million.

First Lady Fatima Maada Bio has also become the subject of intense focus for conservative anti-abortion campaigners, particularly from the US.

Fatima Bio has long been a public champion of girls’ rights, reproductive health, and gender equality.  In 2024, during the We Are Equal campaign in Angola, she stated: “Our bodies should no longer be defined, limited, and violated just because men or society can.” 

But conservatives have intensified efforts to engage with the First Lady since the introduction of the Safe Motherhood Bill.

First Lady Fatima Bio receives an award from Church of Jesus Christ of Latter-day Saints Elder Alfred Kyungu at the Strengthening Families conference.

In June 2025, the Church of Jesus Christ of Latter-day Saints (Mormons) hosted a conference on “Strengthening Families” in Freetown, and invited the Office of the First Lady to collaborate, with the First Lady giving a keynote address.

According to the church, First Lady Bio “has had multiple interactions with the Church, including visiting Church headquarters in Salt Lake City in 2024 and hosting Elder D Todd Christofferson of the Quorum of the Twelve Apostles in her home in 2025”.

Also attending the conference were US anti-rights groups including Family Watch International (FWI), led by Sharon and Greg Slater from the same church. FWI has been campaigning against abortion for more than two decades in Africa, and both Slaters also addressed the conference.

Mariama Zumia Zombo, MP, told Health Policy Watch that she had been heavily influenced against the Safer Motherhood Bill by the Strengthening Families Conference. 

“I am strongly religious. Even though I have a public health background, I am against abortion,” she said. 

Sierra Leone’s First Lady Fatima Bio meets Valerie Huber, a key Trump ally and anti-abortion campaigner, in March

Meanwhile, Valerie Huber, a key ally of US President Donald Trump and one of the drivers of the global anti-abortion Geneva Consensus Declaration (GCD), has held several meetings with the First Lady.

Huber, one of the architects of the GCD and its chief negotiator in Africa, heads the Institute for Women’s Health (IWH).

First Lady Bio described their meeting in March, as a “transformative conversation” that “explored meaningful opportunities for collaboration”.

Health law that became an abortion debate

The first mistake is to call the proposed legislation an “abortion bill.” It covers so much more, including maternal and newborn care, family planning, reproductive health information, adolescent services, protection for vulnerable women and children, emergency care, and setting standards for reproductive health services. 

But abortion has taken the lion’s share of the public conversation. The Bill proposed to legalise abortion up to 14 weeks for any reason, and even later if the continued pregnancy would endanger the life of the pregnant woman or girl, in the case of rape or incest, or a severely malformed foetus.

The government’s main motivation for decriminalising abortion is to reduce maternal mortality. The country has made significant progress, moving from the highest maternal mortality rate in the world in 2000 – 1,682 deaths per 100,000 births – to 354 deaths by 2023, a reduction of 79%. 

But this is still about three maternal deaths per day, with unsafe abortions accounting for around 10% of these deaths, as well as severe complications. There is also a very high rate of teen pregnancy.

Religious objections

The Inter-Religious Council of Sierra Leone (IRCSL) is a powerful group of Christian and Muslim leaders who are opposed to abortion. 

The council asserts that life starts at conception and that abortion runs counter to religious teaching and Sierra Leone’s social and cultural values. The IRCSL has also questioned some of the health statistics used to justify reform. 

Religious leaders and other parties have made representations to Parliament’s Legislative Committee, and a pattern has followed: consultation, compromise, more consultation, and no finalisation.

In January 2025, Catholic Archbishop Edward Tamba Charles, president of the Inter-Religious Council, rejected government claims that the council had already backed the Bill’s proposals. 

He said it was “premature” to comment because amendments were still being considered.

To accommodate religious objections, the government has sought to narrow the most controversial provisions as much as possible. 

By January 2025, the government proposed to restrict access to safe abortion to situations where the life or physical safety of the pregnant woman or girl is at risk, the foetus is not viable, or the pregnancy is a result of sexual violence. 

Religious leaders were given another chance to review the amendments. But the compromise, in short, did not win the argument.

Parliament is divided

At President Bio’s stakeholder meeting in January 2025, Abdul Marray Conteh, chair of Parliament’s Legislative Committee, said that the committee had received 18 position papers, 16 supporting and two opposing the Bill. 

Parliament had also held meetings to go through the religious leaders’ concerns “line by line,” he said. 

Conteh also confirmed in an online TV interview that the Bill is still pending in Parliament, refuting allegations that it had been surreptitiously tossed out. 

However, he did not clearly state whether it would be passed soon. 

But if the majority of position papers submitted supported the Bill, why is consensus so elusive? The answer seems to lie not in the number of position papers but in the political weight of those that oppose it. 

In April 2025, Daniel Brima Koroma, deputy leader of the opposition All People’s Congress (APC) made it clear that the Bill would not be passed into law in the next three years “while MPs with Christian values were in Parliament”. 

Koroma added that legislation regarding motherhood must be appropriate to Sierra Leone’s cultural, traditional, and religious context. 

Women’s advocates decry the delay

Young supporters of the Safe Motherhood Bill.

Purposeful, one of the country’s leading feminist organisations, points out that Sierra Leone has spent more than a decade debating the issue. Back in 2015, the Safe Abortion Bill was passed by Parliament but never introduced into law after religious opposition. 

In June 2025, Dr Ramatu Bangura, co-CEO of Purposeful, wrote in the national media that the Bill it would save lives.

“Without a comprehensive law on reproductive health, our medical professionals and facilities are left vulnerable, girls and women are denied clarity on their rights, and policy remains subject to politics, not public health,” said Bangura.

Bangura also lamented that Sierra Leone has “become a battleground for rights”. 

“Local far-right civil society and religious groups, with the support of far-right American evangelicals, have taken a stand against the passage of the Safe Motherhood Bill, further endangering the lives of Sierra Leonean girls and women,” she warned.

“If policymakers truly want to strengthen families and protect women, then they need to pass legislation that allows us to have the reproductive healthcare that we need and end the pandemic of sexual and gender-based violence that is prevalent in our beloved country.”

So what now?

The answer cannot be another endless round of consultations. Parliament needs to publish the current version of the Bill, including every substantive amendment made since December 2024, and the recommendations received from religious leaders and other stakeholders. 

The Legislative Committee should make clear what is still unresolved. If consultation is the reason for delay, Parliament should tell which consultation is still outstanding, with whom, and why it has taken so long. 

Last month, a coalition of MPs, women’s groups and health professionals meeting in Makeni again called for the Bill to be fast-tracked. 

The meeting, hosted by the Girl Child Network, Marie Stopes Sierra Leone, and Purposeful, also urged the government to act against misinformation about the Bill.

Catherine Zainab Tarawallie, MP, told the meeting that the legislation contains crucial provisions intended to safeguard women and girls during pregnancy and childbirth, according to news outlet Sierraloaded.

A new point of contention is whether women need the consent of their spouses to terminate their pregnancies. This might be the most convincing indication that the Bill isn’t merely waiting for Parliament. It is also waiting for Sierra Leone to decide how far it is prepared to go in reconciling faith, family, individual rights and public health.

Purposeful’s Bangura warns against “allowing religious zealots to hold sway over politicians and policymakers who have a duty to make decisions in the best interest of the most marginalised among us”. 

This country has already spent years debating the question. At some point, consultation has to end, and legislation has to begin.

However, the law alone will not save women and girls. Sierra Leone needs trained health workers, medicines, referral systems, blood supplies, functioning emergency services and money to implement whatever Parliament eventually approves.

Image Credits: Ministry of Health, Sierra Leone, Ministry of Health, Sierra Leone, Church of Jesus Christ of Latterday Saints, Office of the First Lady, Sierra Leone.

Extract from NIH head Dr Jay Bhattacharya’s memo to staff.

The United States (US) National Institutes of Health (NIH) has lifted its ban on funding research projects in South Africa, according to a report by the journal, Science.

The journal quotes an internal NIH memo sent to staff on Wednesday by director Dr Jay Bhattacharya, which says the NIH is exempt from an executive order issued by President Donald Trump in February 2025 halting all “foreign aid or assistance” to South Africa.

NIH grants are different from ‘‘foreign aid or assistance” as they are intended to “foster global scientific exchange,” Bhattacharya wrote in the memo seen by Health Policy Watch. 

“Meritorious research projects located in South Africa are permitted to proceed subject to the principles set forth in the Director’s statement, NIH review processes, State Department review, and NIH policies on foreign award structures.”

He added that the US Congress has “explicitly authorised NIH to engage in international research collaborations”, and that the body’s “funding mechanisms” are not governed by the Foreign Assistance Act.

However, he specifies that all research should “have a clear scientific rationale” for why it is being conducted outside the US, and the “direct potential to generate knowledge applicable to understanding, improving or protecting the health of Americans”.

The US and South Africa have a long history of scientific collaboration, particularly on HIV and tuberculosis.

Trump order focuses on Afrikaners and Israel

Trump’s order claims that the South African government is guilty of two “egregious acts”. One is legislation to “enable the government of South Africa to seize ethnic minority Afrikaners’ agricultural property without compensation”. 

This is a distortion of a 2024 law that enables the government to expropriate land without compensation in exceptional circumstances after following due process. It does not specify ownership by any group, and includes unused municipal land.

The second “egregious act” is South Africa’s case of genocide against Israel in the International Court of Justice, which Trump claims undermines US foreign policy.

“All executive departments and agencies (agencies), including the United States Agency for International Development, shall, to the maximum extent allowed by law, halt foreign aid or assistance delivered or provided to South Africa, and shall promptly exercise all available authorities and discretion to halt such aid or assistance,” states the order.

However, it concedes: “The head of each agency may permit the provision of any such foreign aid or assistance that, in the discretion of the relevant agency head, is necessary or appropriate.”