Dr Tedros addressing the media briefing.

The World Health Organization (WHO) has asked the Russian government for more information about the death of an employee at a Siberian plague research unit, including details about the laboratory tests conducted on her, the WHO Director-General told a media briefing on Thursday.

The WHO has also asked Russia for more details about the public health measures it has imposed, the health status of the woman’s contacts, and whether a second employee has been infected with “pneumonia of undetermined cause”, said Dr Tedros Adhanom Ghebreyesus.

This follows reports on Monday of the death of a 27-year-old female employee at the Irkutsk Anti-plague Research Institute of Siberia and the Far East – possibly of pneumonic plague.

The employee was hospitalised at Shelekhov Hospital on 29 September with symptoms of pneumonia, placed on a ventilator and died a few days later, according to media reports.

Tedros said that the WHO had sent queries to Russia on Saturday, and received a report on Wednesday that “no case of plague had recently been reported in the Irkutsk Oblast” where the research unit is, and that they had “placed about 200 [of the woman’s] contacts in quarantine”.

WHO has also offered Russia technical support related to “plague and lab biosafety and biosecurity”, Tedros said, adding that “we don’t yet have the full picture of this event, and we are not able to conduct a full risk assessment”.

Broken test tube?

Dr Maria Van Kerkhove, WHO director of epidemic and pandemic management.

Some media reports say the employee died after breaking a test tube in the laboratory, but Dr Maria van Kerkhove, WHO director of Epidemic and Pandemic Management, said that employees working in such laboratories would wear personal protective equipment (PPE) and be vaccinated against various diseases.

“We are following up on what type of PPE would be used, and under which conditions? What were they doing with these pathogens?” said Van Kerkhove.

“If there was a lab incident in this lab, there are procedures that must be followed in terms of the assessment that they do in the lab. There would be post-exposure prophylaxis, for example, for this individual. They would probably run tests, so there’s more to come as it relates to what actually happened,” she explained.

“What we have been told is that [Russia] has no case of plague registered in this area, and that no high threat pathogens were detected. So clearly, we would like more information to understand which laboratory tests were conducted, which pathogens were evaluated, and if this individual didn’t die from plague, then then how did she die?” Van Kerkhove added.

Plague is a severe, life-threatening infection caused by the bacterium Yersinia pestis and there are two types: bubonic and pneumonic. 

However, Van Kerkhove said there are thousands of cases of suspected plague every year around the world: “Between 2019 to 2025, 10 countries reported almost 4,000 suspected human plague cases and 423 deaths.”  

Central Asia is the hot spot, and people are infected by bacteria carried by small rodents.

“Sometimes there are small, sporadic outbreaks. Plague is caused by a bacteria. There are antibiotics that can treat this. So if anyone does have an infection with plague, it can be treated.”

International Health Regulations requirements

In terms of the International Health Regulations (IHR), WHO member states are legally obliged to assess public health risks and notify the WHO of any event that may constitute a public health emergency of international concern (PHEIC) within 24 hours of assessment.

Although the WHO submitted its queries to Russia in terms of the IHR on Saturday, it took the government more than three days to respond.

Dr Silvio Ciobanu from WHO’s European region and an IHR expert said countries have to answer four key questions in terms of the IHR: “How severe is the public health impact? Is it unusual and expected? Does it pose a risk of international spread? And does it pose a risk of trade or travel restrictions?”

Ciobanu added that the IHR are “very explicit that a response is expected within 24 hours, and then after that, state parties may require a little bit of extra time to collect all the additional information”.

Thick smog blankets the skyline of Bangkok, Thailand, in 2018.
Thick smog blankets the skyline of Bangkok, Thailand.

International development lenders committed $4.7 billion in 2024 to projects aimed explicitly at reducing air pollution, less than 1% of all international development finance, according to an annual analysis published Tuesday by the Clean Air Fund (CAF).

That was up 58% from $3.0 billion in 2023, nearly matching the 2022 peak of $4.8 billion. A broader measure, which also counts projects where cleaner air is a co- benefit, fell 6% to $28.7 billion, the first annual decline in five years. Five of the ten most polluted countries got less than $2 per citizen, and most of the money came in the form of loans, the analysis found.

Air pollution causes 7.9 million premature deaths a year, nine in ten of them in low- and middle-income countries, according to Health Effects Institute figures. It costs the equivalent of nearly 5% of global GDP, the World Bank estimates, and targeted policies could halve the number of people exposed to dangerous levels by 2040, with economic benefits of up to $2.4 trillion.

“Funding remains worryingly low, concentrated on a limited number of places, and misaligned with countries facing the greatest burden,” said Sean Maguire, executive director for strategic partnerships at CAF.

Top 10 polluted countries and their total air quality funding, 2024.

The data analysed stops in 2024, before the largest annual drop in development aid on record hit the following year. Development assistance for health fell by more than a fifth in 2025, to $39.1 billion, its lowest level in over 15 years, according to estimates by the Institute for Health Metrics and Evaluation (IHME). US health aid fell 67%.

Even before the cuts, air pollution drew little donor money relative to its toll, compared with causes such as food security, humanitarian relief or climate finance. Foundations gave it less than 0.1% of their global giving between 2019 and 2023, a separate CAF analysis found.

“Recent gains remain fragile,” the report says. “The challenge is whether these gains can be sustained and scaled amid shrinking aid budgets.”

The CAF report, produced with Climate Policy Initiative (CPI), tracks 2020-2024 commitments by development banks and donor governments. It excludes domestic budgets and private finance, and nearly nine in ten dollars it counts are loans.

“With development budgets under growing pressure, clean air objectives must be built into wider development investment, so every dollar works harder and delivers benefits for health, climate and economies at the same time,” Maguire said.

Most polluted countries left behind

South Asia receives nearly a third of all air quality funding (2020-2024).

Pakistan, Nepal, Myanmar, Cameroon and the Democratic Republic of Congo, five of the world’s ten most polluted countries, each received less than $2 per person in air quality funding in 2024. India, the second most polluted, was the exception, drawing 19% of all air quality funding that year.

“Air quality funding is not going where pollution exposure and health risks are greatest,” Maguire said.

Pakistan, ranked third for exposure to fine particulate matter (PM2.5), received about 3 cents per person. Between 2020 and 2024, it received $1.7 billion in what CAF calls fossil fuel-prolonging funding, nearly three times the $0.6 billion it received for all air quality projects combined.

Bangladesh, the most polluted country in the ranking, was the largest recipient of fossil fuel-prolonging funding over the five years, at $3.7 billion. Bangladesh’s fossil fuel funding fell 96% in 2024, to $113 million, the report found. Over the five years, it received $7.8 billion in air quality funding.

“Our analysis shows that money is not yet consistently following need, and that countries facing some of the highest pollution levels often have the least access to finance,” said Barbara Buchner, chief executive of CPI.

A wide tent for what counts as clean air funding

Projects that make no mention of air quality made up 84% of the air quality funding CAF counted in 2024.

CAF and CPI find these co-benefit projects through keyword searches of project descriptions in OECD and development bank data, projecting a clean air benefit from the type of project. The methodology captures investments in public transportation like buses, railways and metro lines, wastewater plants and networks, solid waste, household energy efficiency, food waste and soil health. It does not check whether individual projects actually cut pollution.

Transport accounted for 62% of all air quality funding over the five years, with railways and public transport alone making up $53 billion. Two loans worth $5 billion for a high-speed rail line between Mumbai and Ahmedabad made up 14% of South Asia’s air quality funding.

“Investment in railways, public transport and cleaner mobility is demonstrating how better connectivity and economic development can go hand in hand with cleaner air,” said Fu Lu, CAF’s regional director for Southeast Asia. “We need these benefits to be shared by many more people and places.”

Because co-benefit funding tracks wider lending for transport and infrastructure, its growth provides only mixed signals about whether funders are prioritizing clean air specifically.

Total air quality funding, co-benefit projects included, has held at 5.6% of international development funding across the last two five-year periods, while the outdoor share slipped from 0.8% to 0.7%.

The narrower outdoor category leans on similar projects. Under the keyword rules CAF published last year, a transport or water project counts as explicit clean air funding if its description also mentions air, health or exposure. Ten projects made up 53% of outdoor funding over 2020-2024, seven of them rail or public transport, mostly metro lines.

CAF itself found “no structural shift towards explicitly targeting air quality improvements” over the medium term.

Loans dominate co-benefit finance

Loans made up 89% of the $124.6 billion in air quality funding between 2020 and 2024, about $110 billion. Grants accounted for 7.7%. Co-benefit projects, which make no mention of air quality, made up $108.7 billion of the total.

Concessional funding fell from $19 billion to $12 billion, while non-concessional funding rose from $12 billion to $17 billion, 58% of the total. Concessional loans carry below-market interest but still have to be repaid. In 2024, the balance tipped further toward market-rate lending.

In CAF’s figures, which follow OECD aid classifications, concessional finance counts as aid, and aid budgets are shrinking, with the OECD projecting a further 5.8% drop in 2026. The reliance on loans in the donor landscape may put air quality funding beyond reach for countries already carrying heavy debts, according to CAF’s analysis.

Official development assistance from OECD donors fell 23.1% in real terms in 2025, to $174.3 billion, according to preliminary OECD data, as the United States cut its aid by 56.9%.

Across the global South, debt service is absorbing 45% of government revenue in 2025 and exceeds combined spending on education, health and social protection by 20%, according to Development Finance International’s Debt Service Watch.

A narrow measure of fossil fuel finance

About $1.2 trillion is expected to flow into oil, gas and coal in 2026, according to the International Energy Agency’s annual investment report. Governments plan to produce 120% more fossil fuels in 2030 than would be consistent with limiting warming to 1.5°C, according to the 2025 Production Gap Report.

The International Monetary Fund puts explicit fossil fuel subsidies at $725 billion in 2024. Implicit subsidies, three-quarters of them the unpriced cost of air pollution and climate damage, add $6.7 trillion. Removing both would mean 1.1 million fewer premature deaths from air pollution, the IMF estimates.

Against those sums, the report counted $4.7 billion in what it calls fossil fuel-prolonging development finance in 2024, down 48% from 2023, and said that put it level with outdoor air quality funding.

The report counts only international public development finance recorded in OECD data, and only projects that build polluting assets, such as power plants, pipelines and airports, or that promote polluting activities.

Private banks, domestic state spending, guarantees, most export credit and fuel subsidies fall outside it, and road building was dropped from the count this year.

G20 governments and multilateral development banks provided at least $47 billion a year in international public finance for oil, gas and coal between 2020 and 2022, according to the campaign group Oil Change International. About 65% came through export credit agencies, which CAF’s figures largely leave out.

The report warns that continued investment in long-lived fossil fuel assets risks “lock-in to a fossil fuel-dependent development pathway.” It also acknowledges that such funding can support energy access and security in developing countries.

Last year’s edition urged donors to end funding for fossil fuel-prolonging projects. None of this year’s five recommendations mentions fossil fuels.

Image Credits: urf/Getty Images via Canva.

Obesity is growing fastest among children and adolescents

The World Health Organization (WHO) released its first-ever guidelines to address how clinicians should manage obesity in children and adolescents, which include conditional recommendations for obesity medications and even surgery for children over the age of 10.

Since 1990, the number of children ages 5-9 years and adolescents 10-19 years living with obesity has quadrupled, skyrocketing from 2% to 8%. Upwards of 170 million children and adolescents now live with the chronic condition, which increases the risk of a host of medical complications, including type 2 diabetes and cardiovascular disease.

For children especially, obesity can come with stigmatisation, discrimination, and bullying, the WHO notes.

Obesity in children is projected to increase most rapidly in lower- and middle-income countries, where access to healthy foods and exercise now mirrors that in upper-income countries.

The growing global burden of overweight and obese children has led the WHO to issue guidelines for what it terms “person-centered” care, which is a combination of nutrition, physical activity, behavioral management, and in some cases, medication or even surgery.

The WHO recommendations are based on an evaluation of 35 scholarly review articles, but research is still evolving, especially for pharmaceutical-based interventions in children.

Childhood obesity management
WHO’s childhood obesity management recommendations.

Conditional recommendations for medication

For children under 10, the WHO does not recommend obesity drugs or bariatric surgery. Instead, the focus should be on structured interventions such as healthy eating, physical activity, and behavioral change, Dr Luz Maria De Regil, director of the WHO’s Department of Nutrition and Food Safety, told a press conference in Geneva this week.

If this three-pronged approach fails for adolescents, WHO recommends that, in some instances, obesity drugs could be used if the child is mentally and physically prepared. 

Several blockbuster drugs now dominate the weight loss market. In the US, nearly one in five adults reported taking a GLP-1 drug such as Ozempic or Weygovy at some point for diabetes or weight loss. 

The WHO notably added GLP-1s to its recommended guidelines for obesity treatment for adults in 2025, a step in what the global health agency said is a “conditional” sign of approval for the cutting-edge medications that have become so popular.

The picture for children is a bit more complicated, WHO scientists said. While pharmaceutical giants Novo Nordisk and Eli Lilly are both running clinical trials in children as young as six, the WHO had little research to draw on to assess whether the drugs meet the bar of safety or efficacy for children under 10. 

But that hasn’t stopped prescriptions, as a study published in the journal Pediatrics reported that the number of children aged eight to 11 on GLP-1s “increased sharply” between 2019 and 2026. Their study estimates that out of a cohort of over 3.5 million children with obesity – and without diabetes – roughly 20,000 children were prescribed GLP-1s. 

Dr Luz Maria De Regil, director of WHO’s Department of Nutrition and Food Safety, speaking at a press conference in Geneva.

A recent analysis from Lurie Children’s Hospital in Chicago found that GLP-1s may be linked to nutritional deficiencies in children, most notably a lack of vitamin D. The researchers found that only 5% of pediatric patients on GLP-1s received nutritional counseling. 

“As appropriate pediatric use of GLP-1s becomes more widespread, we need to understand the risks during periods of rapid growth and pubertal development,” said Dr Justin Ryder, the study’s senior author and vice chair of research for the Department of Surgery at Lurie Children’s Hospital. 

Ryder, who is also an associate professor of surgery and pediatrics at Northwestern University, commented in a press release that the study highlights the need for proactive nutrition counseling as children are growing, as any deficiencies early in life could have lasting effects.

There are also concerns about adherence to the drug regimen and long-term effects when children start so young, said Dr Laurence Grummer-Strawn, the unit head of Nutrition and Food Safety Action at WHO. 

He cautioned that because obesity is a long-term chronic condition, it is especially important to understand these drugs in children before recommending them. That is why the guidelines don’t focus on or recommend a specific weight loss drug.

“WHO recognizes this is a rapidly evolving field,” said De Regil. Her team is monitoring data as it becomes available on long-term anti-obesity medications in children.

Surgery in severe teen cases

Bariatric surgery also falls under a conditional recommendation for adolescents 10-19 years old. With only a handful of studies to analyze, the team acknowledged that the balance of benefits and harms “are not entirely clear.”

Again, WHO stresses that the decision to undergo an invasive surgery requires “physical and mental maturity” for those with the most severe forms of obesity. 

“That’s why it’s conditional,” said Dr Maria Nieves Garcia Casal, a WHO scientist in the Department of Nutrition and Food Safety. 

The WHO only recommends surgery for those with a Body Mass Index (BMI) for age greater than four standard deviations above the WHO growth reference median, which is a high threshold for a surgical intervention.

Nutrition, exercise, mental health

Ultra-processed food is a staple diet for Mexican 10-year-old Ricky and his mother, Alicia. The WHO recommends dietary interventions to manage childhood obesity.

The guidelines stress that obesity management goes beyond simple weight loss, involving a combination of structured dietary, exercise, and behavior-changing interventions that work best when tailored to the individual.

Digital technologies, including active video games or phone apps that encourage movement,  could also help children manage their obesity, although the WHO’s recommendation is conditional as excessive screen time should be limited. 

The recommendations also emphasise the importance of addressing mental health alongside obesity: “Anxiety, depression, low self-esteem and emotional dysregulation can contribute to unhealthy eating behaviours, physical inactivity and social withdrawal, and children and adolescents living with obesity may experience stigma and bullying that harm their emotional well-being,” the WHO notes in a media release issued alongside the guidelines. 

Worrying trends in low- and middle- income countries

Obesity is on the rise globally and across all regions; however, the rate of increase has mostly plateaued in developed nations, while it is increasing in low- and middle-income countries.

In much of Latin America, sub-Saharan Africa, Caribbean and Pacific Island nations, and South and Southeast Asia, the rate of childhood obesity is rapidly accelerating. In some countries with already high burdens of childhood obesity, like in the US and the Middle East, that rate is mostly stagnant.  

A Nature study published earlier this year noted that the increase in obesity rates in children is happening across regions and afflicting most low- and middle-income countries: Tanzania, Rwanda, Ethiopia, Nepal, Bangladesh, Saudi Arabia, Malaysia, and Chile all saw steady or rapid increases in the past three decades.

“These highly varied dynamics suggest that the social, economic and technological trends that influence the availability, affordability and use of different foods may have helped control the rise in obesity in high-income countries,” the study authors write, “but require policy interventions in low-income and middle-income countries.”

Childhood obesity
Obesity in children is accelerating most rapidly in low and middle-income countries, per a May 2026 Nature article.

Prevention and treatment go ‘hand in hand’

While the guidelines focus on treating obesity in children, the WHO acknowledged the role of addressing a child’s environment, including unhealthy food options in schools, persistent marketing of unhealthy food to children, and the lack of safe places to play. 

Dr Laurence Grummer-Strawn, unit head of Nutrition and Food Safety Action, argued that much of what remains outside of a child’s individual control has deep consequences for their obesity risk. These include whether a child was breastfed, their junk food marketing environment, and their school environment. 

“Countries need to create environments that make healthy diets and physical activity accessible and affordable, while ensuring that children and adolescents already living with obesity can access high-quality care free from stigma and discrimination,” said De Regil. 

“We need to prevent obesity wherever we can, and ensure that those already living with obesity receive the care and support they need.”

Image Credits: Commons , WHO, UNICEF, Nature/ NCD-RisC.

A Chinese candidate reportedly is waiting in the wings to join the race for WHO Director General.

China has nominated a prominent Chinese health official for WHO Director General in the 2027 elections, multiple diplomatic sources have confirmed to Health Policy Watch. 

But there are mixed reports about who that candidate actually may be. Some high-level sources have cited Song Li, a senior Chinese Communist Party official who mounted a failed bid for the post of Regional Director for  WHO’s Western Pacific Regional Office (WPRO) in 2023. 

Others, however, have denied that she is a candidate, noting that after losing the 2023 election, Beijing wants a stronger contender for a global race.

Song Li, Director-General, Department of Women & Children’s Health, National Health Commission (NHC), People’s Republic of China.

Either way, China’s immense and still growing geopolitical range of influence from the Western Pacific to Southeast Asia and Africa means it could mount a serious campaign that could permanently shift the delicate balance of power at the WHO following the withdrawal of the United States from the organization last year.  

WHO election rules hinder transparency

The picture is complicated by the fact that under WHO rules, public disclosure of Song, and any other potential candidate from China or elsewhere, is only required at the end of this month, after the conclusion of the WHO European Regional Committee Meeting on 29 October, the last in the series of WHO regional conferences of member states.  

This is according to the WHO election process rulebook, which creates a one-month gap between the formal submission of nominations to WHO by member states and public disclosure. 

Six prospective candidates have already been announced on the WHO election website, as reported by Health Policy Watch  after nominations formally closed on 24 September.

But their names were published at the discretion of the sponsoring countries, WHO has explained. Nominations don’t have to be formally disclosed until the end of the final WHO Regional Committee meeting, according to the WHO handbook of rules, a spokesperson told Health Policy Watch. 

The Permanent Mission of China to the UN in Geneva did not respond to several Health Policy Watch queries about the DG nomination, sent over the past few days.

Quietly professional – but still a Communist Party official

Song, Director-General of the Department of Women and Child Health in China’s National Health Commission, has sat on several WHO technical committees related to maternal and newborn health.  

At the time of the 2023 campaign for WPRO RD, she was described as “quietly professional” by global health veteran Mukesh Kapila, in a Health Policy Watch analysis of that election campaign. 

“But will China refrain from influencing her so that she can function genuinely independently? Chinese incumbents in international organisations often remain under obligation to their own authorities, and can even be summoned home if they displease their masters,” Kapila, a columnist and Health Policy Watch board member, asked at the time. 

‘No surprise’ for Europeans

Others are asking similar questions now.

“It would come as no surprise if China were to put forward their candidate,” a senior European global health policymaker said in an interview last week with Health Policy Watch on the reports of a China candidate for DG, speaking on the margins of the European Health Forum – Gastein.  “They see a chance to fill the power void that the United States has left behind.”

However, the diplomat expressed doubts as to whether Beijing could mobilize sufficient votes to actually win the race.

While acknowledging the risk of increased polarization within the world’s premier health agency, he described Beijing’s diplomatic approach as “very nuanced,” noting that while Europeans view China as a competitor in some areas, it’s also a partner in others.

Concerns in Washington DC more likely

As the US has withdrawn from WHO, China is filling the vacuum.

But the prospect of a Chinese Director-General is likely to raise very different concerns in Washington as compared to Europe, says Kieran Bligh, a former WHO staff member doing doctoral studies on global health leadership at George Washington University and a Health Policy Watch fellow.

“The bigger risk is that Washington vacates the space and China fills it,” he says. “The WHO could increasingly become a tool used against US interests while (Washington) has no seat at the table due to the US withdrawal from the agency.”

In an early September Bligh predicted that Beijing would soon make a public move in the Director-General race, stating: “China is doing what any serious global power would do: making sure it has influence over who leads the world’s health agency.”

From Asia’s Belt and Road to Central Africa

A coltan mine in M-23 Rubaya, North Kivu, Democratic Republic of Congo. China also plays a key role in the refinement and distribution of this vital mineral.

The potential for China to muster significant votes to any candidate it mounts is significant, observers say. For one thing, China has recently been appointed to the WHO Executive Board (EB) of 34 member states. China joined WHO’s EB governing body in May 2026, after securing the seat at the 2025 WPRO Regional Committee, as reported by Health Policy Watch. 

In February 2027, the Executive Board will select three finalists for the race – out of the bloc of declared contenders. 

Africa’s 54 WHO member states often vote in a bloc on many major WHO policy issues. Forty-seven African states are affiliated with WHO’s African Region, while another seven North and Horn of Africa nations are members of the Eastern Mediterranean Region of the WHO. 

China’s outsized financial and political influence in Africa extends everywhere on the continent. Chinese firms, for instance, control 70-80% of the copper and cobalt mining in Ebola-stricken Democratic Republic of Congo, including not only legitimate ventures but hundreds of illegal extraction sites in South Kivu province alone where impoverished African families labour. It also plays a key role in distributions of other vital minerals like coltan, critical for electronics, and for which DRC produces 40% of the worlds supply. Coltan is mined artisanally and smuggled illegally over the border to Rwanda and then onward to China and the United Arab Emirates for refining. 

Child laborers in one of the hundreds of illegal mines in the DRC’s South Kivu province – most of which are operated by Chinese nationals.

Across the continent, China has invested nearly $200 billion in port, rail and road projects, as well as modern agrobusinesses, which it is increasingly operating as well. Local African markets are rife with cheap imports of Chinese consumer goods.  

China is the world’s largest official creditor and the single largest bilateral source of official-sector financing to the developing world, according to AidData. Similarly, the massive Belt and Road Initiative has extended Beijing’s economic and political influence across Asia, Africa, the Middle East, Europe and even Latin America.

“Money matters,” Bligh says. “Those influences do not disappear when governments walk into a secret ballot [at the Executive Board level, or later, at the full World Health Assembly], and debt exposure can be powerful leverage.” 

He argues that if a Chinese candidate were to win the DG race, burning issues like the origins of the SARS-CoV2 virus would likely be buried forever, and WHO collaborations in future independent inquiries could be suppressed. 

To date, China has never responded to WHO requests for blood samples or genetic sequences of the virus from the first patients infected in Wuhan or detailed information about the status of animals sold at Wuhan’s wet markets – where the virus first emerged in late 2019. 

Nor has it provided detailed data on the research work and biosafety conditions in the Wuhan Institute of Virology. These are the two leading sources from which scientists believe the virus first began to circulate widely. 

Wuhan’s Huanan seafood market was shuttered early in 2020, down after COVID emerged in the vicinity. But China’s government has provided little data to WHO  on the early days of the SARS-CoV2 virus circulation among animals or humans.

WHO needs competent, credible leadership most of all

Magda Robalo, president and co-founder of The Institute for Global Health and Development (IGHD), prefers to see the glass half full rather than empty. 

“Supporters might argue this reflects the growing importance of Asian economies in global health. Critics might worry about political influence over sensitive issues involving transparency, disease reporting, or geopolitical disputes,” the former Guinea-Bissau Minister of Health told Health Policy Watch.

“WHO needs a competent, credible and strong leader, able to build consensus among its 194 member states and reform WHO to focus on science, its core strengths and functions, irrespective of nationality or sex,” she said. 

“One cannot ignore the fact that current geopolitical tension, mistrust, fragmentation and erosion of multilateralism will certainly increase scrutiny on candidates’ ties and citizenship. A Chinese DG candidate could be seen by some countries as reinforcing China’s influence in international institutions. Health is political after all.”

“[But] China has significantly expanded its role in global health over the past two decades through investments in health systems, disease surveillance, vaccine production, and health aid, particularly in Africa and Asia,” she concluded.

Already the largest WHO contributor and heading FAO 

Dongyu Qu – FAO DG: ‘ We’re not allowing you to play the game here of human rights.’

Long overshadowed by high-income WHO member states in the Americas, Europe and Asia, China is today WHO’s largest state contributor in terms of assessed dues, paying the sum of $137.8 million in 2026.

At the 2025 Assembly, Vice-Premier Liu Guozhong pledged an additional $500 million over five years, with a line aimed at Washington: “The world is now facing the impacts of unilateralism and power politics.” 

However, the WHO notes that the pledged additional amount is still  “to be confirmed”. 

The US, meanwhile, owes $280.9 million in membership arrears and faces suspension of its vote at the very Assembly that will elect the next DG. 

China already holds the top job at another major UN specialized agency. Dongyu Qu, a Chinese national nominated by Beijing, has served as Director-General of the UN Food and Agriculture Organization since 2019 and is now in his second term.

Dongyu recently came under fire for his scathing comments about other senior FAO officials “playing the game of human rights” at the Rome-based agency.  “We’re not allowing you to play the game here of human rights,” he was filmed saying at a recent FAO assembly. “Of course, human rights is very important. But we have the human rights agency in Geneva. If you want to take care of that, go there.” 

Aside from Dongyu’s views, the fact that he holds the DG position at a UN agency is an informal barrier to a Chinese nominee winning the election for WHO DG, as countries have typically preferred that powerful leadership roles are distributed amongst UN member states, rather than concentrated with one nation. 

Meanwhile, the secrecy surrounding the definitive list of candidates also opens the way for a closet game of poker, in which a country with an undisclosed candidate could potentially leverage commitments from one of the other, publicly declared competitors for post-election policies or appointments in exchange for withdrawing quietly from the race. 

Not the first time China has held senior leadership roles at WHO

Dr Margaret Chan, WHO Director General from 2006-2016

But this would not at all be the first time that senior posts were awarded based on nationalities and not only competencies. 

In fact, a DG’s appointments of his or her Assistant Directors Generals and other senior managers are often payback for support received during the campaign. 

It would not be the first time, at all, that a Chinese national held a senior position at WHO. From May 2023 – Jun 2025, Ailan Li served as an Assistant Director-General, Universal Health Coverage, Healthier Populations under Dr Tedros Adhanom Ghebreyesus.

Following the 2025 WHO budget crisis leading to staff reductions, Li’s position was eliminated. She is now the WHO Representative to Thailand.

Moreover, a Chinese national, Margaret Chan, first elected in November 2006 and holding the Director General’s post from 2007 to 2017, the first ever to do so. 

But Chan was a native of Hong Kong and a senior health official there during the first SARS outbreak – a period that preceded China’s brutal 2020 crackdown on dissent, Hong Kong’s free media and its semi-autonomous governance, which the island had seen since 1997. Chan was also a dual Canadian national.

Secrecy adds to potential leverage against other candidates

The candidacy of any high-level member of the Chinese Communist Party, if it were to materialize, would still be unprecedented in terms of the level and scope of influence it would open up to Beijing.  

Equally unprecedented is the amount of leverage that a shadow candidate nominated by Beijing or by any other member state could wield on other DG competitors, between now and the end of the month, when full disclosure will be required by the WHO rules.  

The technical loophole that has emerged, therefore, is in how the horses leave the gate. This is a muddy start to a race that most global health pundits describe as a crossroads that could determine the very survival of WHO as a robust, independent global health entity in the UN family.  

Correction: an earlier version of this story said that Margaret Chan was WHO Director General from 2006-2016, when in fact she was elected in November, 2006 but only took over the position in 2007, serving until 2017. 

Image Credits: Wikipedia Commons, WHO, ©The Rudin Group , MONUSCO/Sylvain Liechti, Harvard-Kennedy School, Deutsche Welle.

Extreme heat is raising the risks of pregnancy and early infancy as the world warms. Health advocates are pushing to make mothers and newborns a priority at COP31.

Nearly three in four maternal healthcare workers say extreme heat-related complications among pregnant women have increased over the past five years, according to a five-country survey released as climate ministers gathered in Fiji for the last major meeting before COP31.

The poll of 1,001 obstetricians, midwives, nurses and other maternity staff in Australia, Brazil, India, the UK and Zimbabwe, commissioned by Wellcome Trust, found 73% had seen more heat-related cases or complications in pregnant women. Another 76% reported an increase in foetal or newborn health issues.

“Midwives and doctors from countries across five continents are telling us that extreme heat is affecting the health of pregnant women and newborn babies,” said Julia Gillard, Wellcome’s chair and a former Australian prime minister. “No woman should have to fear that extreme heat will harm the baby she is carrying.”

Almost all respondents said they had personally cared for a pregnant woman (98%) or a baby (99%) whose health they believed extreme heat had harmed, and 92% said they wanted more training and resources to protect pregnant women during extreme heat.

The findings were launched on Monday at the opening of Wellcome’s Birthright campaign in Fiji, on the first day of the pre-COP ministerial meeting, where UN climat chief Simon Stiell warned that “pregnancy and birth are now a new fault line in the global climate crisis.”

“Climate-driven extreme heat during pregnancy is increasingly linked to premature birth, stillbirth, low birth weight, and maternal complications,” Stiell said. “A changing climate must never be accepted as a reason pregnancy and birth become less safe.”

“Pregnancy should be a time of hope,” he added. “But for millions, it is becoming a time of anxiety, as climate impacts fill everyday life with risk.”

Over half of respondents (55%) said clearer national or international guidance would help them provide better care. Wellcome is calling on the World Health Organization (WHO) to produce its first clinical guideline on heat, pregnancy and the postpartum period, and on governments to write pregnant women and newborns into their national climate and health plans.

“As the planet continues to heat up because of anthropogenic climate change, more mothers and babies will be put at risk,” said Gillard. “Extreme heat is an invisible killer, but pregnant women must not be invisible.”

Pressure on maternity services

Mothers and their newborns will face higher risks as the planet continues to warm, driving extreme heat to new levels.

About a quarter of respondents, 23%, had seen pregnancy complications requiring additional monitoring or treatment that they linked to extreme heat. Among newborns, 36% reported dehydration or heat-related illness, 34% low birth weight or restricted growth and 33% difficulties with feeding, breathing or regulating body temperature.

Over a quarter (27%) said heat is making it harder for pregnant women and their families to travel to or reach care, while 29% reported a rise in urgent or emergency presentations. Some 28% said they had struggled to store medicines, supplies or equipment safely, and 24% had dealt with interruptions to electricity, water or cooling.

Health workers in Zimbabwe reported the sharpest rise, with 85% saying heat-related complications in pregnant women had increased, compared with 79% in Australia, 74% in Brazil, 66% in the UK and 62% in India.

The poll, run online by Censuswide between 17 September and 1 October, records what health workers say they have seen rather than clinical case records. Wellcome’s methodology notes the results are unweighted, not nationally representative and do not establish that heat caused individual complications.

None of the five countries surveyed is classed as low-income by the World Bank, yet pregnancy is already far deadlier in the poorest countries. About 260,000 women died during or after pregnancy and childbirth in 2023, according to WHO, and roughly 70% of those deaths occurred in sub-Saharan Africa.

A woman in a low-income country faces a one in 66 lifetime risk of dying from maternal causes, compared with one in 7,933 in a high-income country, leaving the world far off track for its 2030 target. In sub-Saharan Africa, a 15-year-old girl faces a one in 40 lifetime risk of dying from a maternal cause, according to UN estimates for 2020.

Almost 95% of maternal deaths that year occurred in low- and lower-middle-income countries, while 73 countries, most of them in Europe or Latin America and the Caribbean, were estimated to have 20 or fewer maternal deaths. Yet a 2025 review of 83 heat-health action plans from 24 countries found none from low-income economies. Only 52% named pregnant women as an at-risk group, 39% newborns and 14% postpartum or breastfeeding women.

“We already know many of the solutions to protect people, from early warning systems to cooler buildings,” said Madeleine Thomson, Wellcome’s head of climate impacts and adaptation. The challenge, she added, is reaching “those who need them most.”

A test of climate action

Simon Stiell, the UN climate chief, called addressing the impacts of extreme heat on newborns and pregnant women “a new fault line” in the climate fight.

Ministers from more than 50 countries are meeting in Nadi until Thursday, with a leaders’ event in Tuvalu, in the last major round of talks before COP31 opens in Antalya, Türkiye, on 9 November.

Speaking at the Birthright launch, Stiell said advice to stay cool offers little to women with “no cool place to go,” and that safe childbirth already depends heavily on geography, income and access to care. “Without action, extreme heat will widen that injustice.”

His three priorities for governments are: writing pregnancy and newborn care into national adaptation, health and heat plans; turning evidence into protection through guidance, training and heat alerts; and collecting better data.

“Harm that is not counted is too easily ignored,” he said, adding that governments need data to track where the risks are rising, who is most exposed, which protections work and where finance and technology should go.

Stiell tied the issue to the fight over adaptation finance, urging governments to deliver on commitments made at COP30 in Belém, and pointed to the Belém Adaptation Indicators and Gender Action Plan as ways to measure climate-related health risks.

“A newborn’s healthy start must never depend on a family’s ability to escape the heat,” he said.

Türkiye’s presidency has made “Dynamic and Resilient Health Systems” one of 10 priority themes on its COP31 Action Agenda, and the summit will open with a dedicated Health Day.

That agenda is voluntary, however, and health has no standalone item in the negotiations. Its foothold in the formal text runs through the Global Goal on Adaptation, under which countries adopted 59 indicators at COP30, eight of them on health.

Record heat, rising risks

The survey follows a northern summer in which 33 countries recorded their hottest July on record, according to an AFP analysis of Copernicus data. The US National Oceanic and Atmospheric Administration found July 2026 tied with July 2024 as the hottest on record globally.

Last year’s Lancet Countdown estimated that there were 546,000 heat-related deaths per year over the most recent decade, and found that 84% of heatwave days between 2020 and 2024 would not have occurred without climate change.

A 2024 meta-analysis of 198 studies across 66 countries found the odds of preterm birth rose 4% for every 1°C increase in heat exposure and 26% during heatwaves. The odds of obstetric complications rose 25% during heatwaves.

“With El Niño pushing temperatures higher, the failure to act is costing lives,” said Thomson. “Extreme heat, fuelled by climate change is impacting our way of life and our health – and yet many countries are not prepared.”

Zimbabwean Health Minister Dr Douglas Mombeshora launched the country’s national health plan in July, committing more money to health – but this won’t be enough to fill the gap left by the withdrawal of US aid.

HARARE – In March, 27-year-old Jemitius Gangata succumbed to malaria in Mahombokombe village in Zimbabwe’s Mashonaland West Province, becoming part of the country’s growing malaria statistics. 

By mid-April, the country had recorded over 65,000 malaria cases and 174 deaths, almost double the numbers from the same period last year, when 36,000 cases and 85 deaths were recorded, according to Save the Children, a non-governmental organisation. 

Gangata’s widow, 25-year-old Miriam Chasi, said nurses delayed giving her husband malaria treatment because they said there was a shortage.

“Nurses claimed that there were so many malaria patients who wanted the treatment drugs,  which were said to be in short supply. We couldn’t do anything to save my husband’s life and we lost him,” said the mother of two.

Save the Children warned earlier this year that US aid cuts have led to “premature ending of the second phase of the country’s largest malaria programme – Zimbabwe Assistance Program in Malaria – which had been on track towards eliminating the deadly disease”.

Zimbabwe had achieved some of the largest declines in malaria incidence and mortality in the world, reducing cases by 76.6% from 2023 to 2024.

Save the Children, one of the four partners implementing the malaria programme, said the closure of the programme has led to “shortages of insecticide‑treated mosquito nets, delays in vector control operations, and weakened disease surveillance, with heavy rainfall and fluctuating weather patterns further promoting the spread of the disease”.

Megan Rabbitt of Malaria No More said that US funding for malaria in 2025 amounted to almost $20 million.

This money funded essential drugs, commodities and laboratory systems, and the jobs of approximately 8,300 health workers are in jeopardy, “reducing national capacity for case management, disease surveillance, and outreach”, said Rabbitt.

A resurgence of malaria in Zimbabwe also threatens its neighbours, Botswana, Mozambique, South Africa, and Zambia. 

Meanwhile, the Global Fund’s grant for the country has been lower for the past two grant cycles as it, too, is facing financial challenges. 

global fund
Children under the age of five are worst affected by malaria, which is surging in Zimbabwe amid funds shortages.

Gaping hole in the budget

Zimbabwe’s health budget faces gaping holes after the United States announced it would end all bilateral health funding to the country by the end of September – one month before malaria season begins. 

“US government contributions comprise 54% of national healthcare spending, supporting a range of clinical care, laboratory systems, health workforce, commodities, and community-based programs,” according to Health GAP, the global access project. 

The US President’s Emergency Plan for AIDS Relief (PEPFAR) has spent over $1.7 billion in Zimbabwe since 2006.

“Of the 1.3 million Zimbabweans living with HIV, more than 1.2 million are now on life-saving HIV treatment thanks to PEPFAR and support from other donors,” according to a 2023 statement by PEPFAR, which has been substantially reduced since Trump assumed office and is being replaced by the bilateral MOUs.

Researchers project that there could be over 75,000 new HIV infections in Zimbabwe within a year “as a consequence of full PEPFAR withdrawal and no additional government or international support”.

When the National AIDS Council (NAC) addressed the Zimbabwean Parliament last month, it appealed for more domestic financing for the HIV response, warning that the declining donor funding placed pressure on the AIDS Levy and threatened the sustainability of prevention and treatment programs.

The country’s AIDS Levy, introduced in 2000, entails a 3% income tax for individuals and a 3% tax on profits of employers and trusts. NAC administers the funds, and 50% goes to antiretroviral medication.

However, NAC’s Amon Mpofu told MPs: “The AIDS Levy, while it has been resilient over the years, remains inadequate given the demands of the response, particularly at this moment. We therefore need an expanded base of domestic financing to sustain the gains we have made and meet emerging needs.”

Breakdown in talks

US Ambassador to Zimbabwe Pamela Tremont at an event hosted by the Zimbabwe Health Initiative in 2024, when her country was still funding Zimbabwe’s health programmes.

The US announcement follows the Zimbabwean government’s decision not to pursue a bilateral MOU with the US under its “America First” Global Health Strategy. The MOU was worth $367 million over five years.

A leaked letter from Albert Chimbindi, Zimbabwe’s Secretary for Foreign Affairs, describes the MOU as “clearly lopsided”, adding that it “blatantly compromises and undermines the sovereignty and independence of Zimbabwe”.

US Ambassador to Zimbabwe Pamela Tremont confirmed the US withdrawal in February.

“From that time, civil society advocated behind the scenes to try to restart MOU talks – on terms that were fair for Zimbabweans,” according to Health GAP’s Asia Russell. 

But the talks did not resume, with Russell blaming hard-headedness on both sides. 

“Ambassador Tremont insisted talks would only restart if Zimbabwe’s government reached out to them. Because President [Emmerson] Mnangagwa had already issued a formal communique severing talks, easy paths to compromise were unrealistic,” she said.

“The US and Zimbabwe dug into their respective positions; in Zimbabwe, political leaders falsely claimed the national government would cover gaps in essential healthcare services left by a sweeping US health program shutdown.

“Tremont repeated her claim that she would be willing to restart talks if Zimbabwe’s government reached out to the Embassy. She must have known that without a détente she refused to pursue, there was no chance Zimbabwe’s government opposition to the MOU would dissolve.”

Government fails to outline plan

However, it is unclear how Zimbabwe plans to tackle the shortage, as Health Ministry officials failed to answer questions from Health Policy Watch on how it plans to tackle its obligations amid US health aid cuts.

In July, the health ministry launched an ambitious National Health Strategy 2026-2030 aimed at “building a resilient, sustainable and people-centred health system”. At its launch, Health Minister Dr Douglas Mombeshora said his government would “increase domestic funding for health to at least 15% of total government expenditure and reduce out-of-pocket payments”.

At an event hosted by the UN Population Fund (UNFPA) on the sidelines of last month’s UN General Assembly Summit, UNFPA revealed that Zimbabwe has committed over $250 million to upgrading hospitals countrywide, with 30% of this dedicated to maternal and child health infrastructure. Zimbabwe has also committed $2.25 million annually for family planning commodities in 2026 and 2027, according to UNFPA.

However, these measures are not enough to cover the shortfall.

Back in March, the Zimbabwe National Network of People Living with HIV (ZNNP+) met with Health Minister Mombeshora to express the fear of their members at the looming cuts.

According to a ZNNP+ media release, Mombeshora told them that the country “has  ARV stocks of between six and 30 months, with further shipments expected throughout the year; the government has ringfenced health-related taxes to cover the expected funding gaps, and [it is] putting in place long-term measures including the identification of further revenue sources to fund HIV, TB and malaria programmes.”

ZNNP+ responded: “While we take note of the assurances, there is need for a clear Some civil society activists have also questioned whether the Zimbabwean regime, mired in decades-long corruption, will foot the national health bill on its own – particularly as the country’s PEPFAR grant covered over 40% of the country’s HIV bill.

Other civil society groups are also sceptical about the government’s ability to deal with the crisis.

“The government of Zimbabwe needs to step forward and prioritise funding the health sector more than before to avoid a crisis,” said Vivid Gwede, former programme manager for Zimbabwe Alliance. This philanthropic initiative pools donor funds to provide grants, technical support, and capacity building for civil society groups.

“That means plugging resource leakages and cutting unnecessary expenditure. As usual, preventive health measures need to be stronger to reduce treatment burdens. Anything short of that will spell a public health crisis,” added Gwede.

Zimbabweans living with HIV fear that they may not be able to get their ARV treatment.

Tuberculosis surges amid drug shortages

Tuberculosis has already started to resurge amid the US health aid cut, which started 18 months ago when Donald Trump became US president.

Denford Macheza, a 49-year-old resident in Harare’s Dzivarasekwa Extension, has been bed-ridden with drug-resistant TB for over a month, and blames his condition on a shortage of drugs at his local hospital.

“I was told on two occasions to come back for my pills as they were not yet available, and when I went back to the hospital for the third time, I obtained them. But now I suffer from a drug-resistant TB strain and I just hope I will be fine,” Macheza told Health Policy Watch.

Pregnant women have also not been spared. Harare resident Jack Munondo blames the death of his pregnant wife on a shortage of drugs at their local clinic.

Her labour needed to be induced, but there were no drugs at their local clinic.

“The baby died before birth because my wife couldn’t get the drug to induce her to exert pressure to push the baby out and the nurses just looked on helplessly, shouting at each other,” Munondo told HPW.

Uncertainty for people living with HIV

Zimbabwe has made significant progress against HIV, including reaching the UNAIDS 95-95-95 targets among the adult population, meaning 95% of people living with HIV know their status, 95 of those diagnosed are on treatment, and 95% on treatment are virally suppressed. 

Many Zimbabweans living with HIV are fearful of what the health cuts might bring.

“Now, with the US having cut down health support, we are going to have poor adherence to treatment. Imagine now, people are going to be paying huge amounts of money to get tested for viral load whilst with the US funding, we were getting those for free,” Tinotenda Mapuranga, who was born with HIV, told HPW.

Kensington Marufu, also born with HIV, is trying to keep a positive outlook.

“As an individual, I remain hopeful. I believe that the gap created by the withdrawal of US support can be addressed through a combination of domestic resources, existing development partners, new donors and innovative financing mechanisms,” said Marufu. 

“The priority must be to ensure that people living with HIV continue to access their ARVs and essential services without interruption. Ultimately, the success of this transition should be measured by one thing: whether the person who walks into a clinic tomorrow can still receive the treatment they need and walk home with confidence,” 36-year-old Marufu, a lawyer by profession, told HPW.

Dr Henry Madzorera, Zimbabwe’s Health Minister between 2008 and 2013,  claimed that the country “does not need more external aid”.

“We need better and more accountable management of the resources the Lord has already given us. Together, we will prosper,” said Madzorera, adding that, “with enough political will, Zimbabwe can finance her healthcare and achieve universal health coverage.”

Nurse warns of hardship ahead 

A Zimbabwean health worker administers an HIV test.

Warren George, a nurse working in rural Masvingo, said that the aid cuts will make his job harder.

“It is really a difficult situation. We can’t really say the government of Zimbabwe is in a position to become a standalone supporter in terms of finances to face the health burden that we already have,” George told HPW.

“Even with health aid available, it was not easy. Personally, I have been doing the tuberculosis program in Chivi district, and with the funding that was available, there were still shortages in medical supplies,” said George. “The US health aid has been fostering something the Ministry of Health and government here cannot do alone.”

George said that, before the Trump cuts, community outreach agents used to track people living with HIV to check that they were adhering to treatment.

“We will have challenges with people defaulting on HIV/AIDS treatment because of zero monitoring owing to lack of resources,” added George.  

For Rashweat Mukundu, a researcher at the International Media Support (IMS), much harder times may lie ahead: “I have not seen any concrete policy propositions on how the Zimbabwean government will close this gap, but I guess the responsible authorities are fully aware of the demands that come with the withdrawal of American funding, and the vulnerability that Zimbabwe finds itself in regarding health funding,” he told HPW. 

Meanwhile, Health GAP’s Russell proposed several actions to alleviate the crisis. These include an emergency donor conference focused on Zimbabwe’s funding cliff, global partners pushing the US and Zimbabwe “to come back to the negotiating table immediately” to resolve concerns, and the US Congress “earmarking appropriated global health funding for Zimbabwe, which would effectively override this decision”.  

Image Credits: UNICEF Zimbabwe, Emmanuel Museruka/ MMV.

Gastein closing podium on EU health policy with the panellists from left to right: Natasha Azzopardi Muscat, Martin Seychell, Chris Fearne, Magda Robalo, Ilona Kickbusch, and Ricardo Baptista Leite.
Gastein closing panel on EU health policy with the experts from left to right: Natasha Azzopardi Muscat, Martin Seychell, Chris Fearne, Magda Robalo, Ilona Kickbusch, and Ricardo Baptista Leite.

Global health has moved from an area of mutual cooperation to one dominated by “high politics” and division, observed Ilona Kickbusch at the European Health Forum Gastein (EHFG) last Friday (2 October).

Leading the closing panel, the founder of the Global Health Centre at the Graduate Institute in Geneva, highlighted how recent voting at the UN General Assembly demonstrates that nation-states increasingly split and vote instead of searching for consensus.

Gathering 420 health leaders, pharmaceutical executives, and multilateral diplomats in the alpine town of Bad Hofgastein, Austria, this year’s annual forum took place against the backdrop of this escalating historic shift in multilateral governance

Across its four-day agenda, the conference crossed critical policy domains – from climate change and vector-borne diseases to de-risking late-stage biotech innovation, tackling venture capital shortages, and addressing youth mental health.

Faced with new security threats and the geopolitical fallout of the war in Ukraine, panellists directly confronted persistent patient access divides, the upcoming EU budget trade-offs favouring military defence over health infrastructure, and friction surrounding health sovereignty.

While participants in the closing session unanimously agreed that the post-World War II status quo is collapsing and that “things must change,” the debate over what a future health architecture should look like remained fundamentally unresolved.

The struggle over ‘health sovereignty’

Outgoing EHFG President Clemens Martin Auer addresses conference attendees.
Outgoing EHFG President Clemens Martin Auer addresses conference attendees.

Framing this year’s conference around health as a strategic pillar of European unity, outgoing EHFG President Clemens Martin Auer issued a stark warning against the rise of far-right extremism and anti-EU rhetoric across the continent.

Auer cautioned that these political movements are co-opting the concept of “sovereignty” to promote short-term nationalism, isolationist agendas, and a retreat from European integration and multilateralism.

“They have a different concept of sovereignty. They use it to go back to the old, good days – they think that they were wonderful days – of nation-states, of the sovereignty of nation-states,” Auer warned, calling on the health community to actively fight against that notion. “It is of utmost importance that we do talk about sovereignty and reclaim this term,” he added.

In contrast to strict nation-state control, health leaders defined true health sovereignty as collective capability built on cross-border cooperation, pooled resources, and trust –  arguing that no single nation can independently defend against pandemic threats, supply chain disruptions, or global health crises without European solidarity.

“When we talk about health, no country, no matter how large or powerful or rich it is, can be absolutely sovereign if we take it from a power and control perspective,” underscored Natasha Azzopardi Muscat, director for health systems in the World Health Organization’s (WHO) Europe Region, adding that “interdependence, solidarity, and sharing is not charity, it’s survival.”

EU pragmatism: Mutual interest over philanthropy

Sovereignty and strategic autonomy: Panellists debate funding transformative health technologies to bolster EU competitiveness and patient access at the European Health Forum Gastein.
Sovereignty and strategic autonomy: Panellists debate funding transformative health technologies to bolster EU competitiveness and patient access at the European Health Forum Gastein.

Faced with a fundamentally changing geopolitical landscape and budget constraints, European Commission officials stressed that future international health engagement must be driven by mutual political interest rather than charity. This comes as the EU reframes its own strategic posture around competitiveness and strategic autonomy – key themes that dominated discussions throughout the Gastein forum.

Martin Seychell urges global health partnerships driven by mutual political interest.
Martin Seychell urges global health partnerships driven by mutual interest.

“We are not a philanthropic organisation. We are a political organisation, and we gauge our success or failure politically,” stated Martin Seychell, deputy director-general for international partnerships at the European Commission.

Seychell argued that health sovereignty must not be misunderstood as an inward-looking retreat or a denial of solidarity, but as a commitment to capacity building and resilience. He emphasised that fostering external dependency offers Europe no strategic advantage, as dependency reduces Europe’s own political manoeuvrability and forces impossible moral choices when budgets shift.

To build local capability, he highlighted EU initiatives under the Global Gateway framework which have mobilised €2 billion to support local vaccine, medicine, and health technology biomanufacturing in South Africa, Rwanda, Ghana, and Senegal. However, he cautioned that international aid budgets alone cannot meet global health needs, urging a move from “addition to multiplication” by using public funds to de-risk private investment and support domestic resource mobilisation in partner countries.

Demands for a global power overhaul

Magda Robalo calls for equal partnerships and an end to charity.
Magda Robalo calls for equal cooperation and an end to charity.

While this call for cooperative sovereignty and pragmatic partnership found broad intra-European consensus, the concept implies something entirely different from a Global South perspective. The core problem lies in global power dynamics that have remained fundamentally unchanged since World War II, stressed Magda Robalo, president of the Institute for Global Health and Development and former health minister of Guinea-Bissau.

Referring to the “Accra Reset” initiative aimed at securing health sovereignty for African nations, Robalo rejected traditional donor-recipient paradigms. “We are not going to continue begging,” she said. “Solidarity and charity are not the same. And what the Accra Reset is saying is enough of charity. We want to work together on equal terms.”

Addressing the frequently invoked concept of trust, Robalo pointed out that during COVID-19, countries like South Africa and Botswana were denied vaccine access despite having the money to purchase them. She stressed that genuine health sovereignty in developing nations cannot rely on trust alone without fundamentally revising international trade rules, post-WWII financial architecture, and intellectual property (IP) regimes – systemic boundaries that European funding initiatives and investment toolboxes continue to leave unaddressed.

Realpolitik and the rise of blunt transactionalism

Donald Trump addresses the UN General Assembly, representing a shift toward open transactionalism and realpolitik that is also reshaping global health governance.
Donald Trump addresses the UN General Assembly, representing a shift toward open transactionalism and realpolitik that is also reshaping global health governance.

Turning back inward into the logic of EU strategic posture, panellists framed global health policy as increasingly shaped by realpolitik and transactionalism.

Chris Fearne highlights the growing impact of realpolitik on health.
Chris Fearne highlights the growing impact of realpolitik on health.

Citing the shifting diplomatic tone at the UN General Assembly, Maltese Foreign Affairs Minister Chris Fearne pointed to US President Donald Trump’s assertion that “to the victor go the spoils” as emblematic of the current global order.

In this zero-sum environment, health is no longer insulated from geopolitical bargaining, forcing policymakers to navigate an arena where alliances are negotiated on transactional terms rather than shared humanitarian ideals.

Fearne raised this warning specifically to ensure that health policy remains a core pillar of EU strategy amidst competing political demands.

Pointing to upcoming negotiations on the EU’s next long-term multi-annual financial framework (MFF) budget, he cautioned that health infrastructure budgets risk being severely reduced to fund military defence and industrial competitiveness.

He urged health advocates to break out of their policy bubble and take political initiative, stressing that “your voice needs to come out beyond this beautiful village into the wider world.”

Ricardo Baptista Leite warns against selling health data and risking AI dependencies.
Ricardo Baptista Leite warns against selling health data and risking AI dependencies.

One of the most urgent frontiers where health leadership is currently required is the governance of artificial intelligence. Ricardo Baptista Leite, director of Health AI, warned that governments selling citizen health data for short-term financial gain are “betraying the trust and mandate given by the people” and creating dangerous new forms of external dependency.

Cautioning that AI will either become the world’s greatest equaliser or its greatest divider, Baptista Leite stressed that states and civil society must build sovereign capability to govern the technology locally rather than ceding control to tech corporations.

WHO dilemma in an unresolved global health architecture

Navigating this increasingly transactional and polarised landscape leaves international bodies in a precarious position. WHO’s Muscat articulated the fundamental governance dilemma currently confronting the world’s prime health organisation: “Do I dilute principles around human rights for the sake of consensus, or do I stick with them even if this means that consensus is not possible?”

Muscat pointed to a shifting climate where health negotiations – particularly around human rights, gender equality, and sexual and reproductive health – have become deeply politicised.

Synthesising this breakdown as the session drew to a close, chair Kickbusch observed that “money doesn’t solve the problem of power,” emphasising that neither increased financial aid nor recycled diplomatic formulas can resolve the structural crisis of global health governance.

As the Gastein forum came to an end, the closing debate exposed an objective structural contradiction between the Global South’s demand for a fundamental redistribution of power and the EU’s approach of managing international cooperation through existing instruments based on mutual interest while reorienting its internal policy toward industrial competitiveness and regional sovereignty.

See related topic:

European Union Must Seize Opportunity to Create Equitable Health Systems 

Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen.

COVID dropped out of the 10 leading causes of deaths, while noncommunicable diseases caused 74% of deaths worldwide in 2023.

COVID-19 dropped out of the world’s 10 leading causes of death in 2023 for the first time since the pandemic began in 2020, and only two years after it topped the list, according to new World Health Organization estimates released Friday.

The virus directly killed an estimated 0.9 million people in 2023, ranking 14th, as global life expectancy climbed back to near its pre-pandemic level. WHO declared an end to COVID-19 as a global health emergency in May that year.

Revised figures now rank COVID-19 as the world’s leading cause of death in 2021, with 9.4 million direct deaths. WHO’s earlier estimates had placed it second that year. Together with 5.3 million deaths in 2020, the new figures put the virus’s direct toll in the first two years of the pandemic at 14.7 million.

Figures WHO published in 2024, based on an earlier round of estimates, showed the pandemic had cut global life expectancy by 1.8 years to 71.4 years between 2019 and 2021, back to 2012 levels.

By 2023, global life expectancy at birth had recovered to 73.3 years, against 73.4 years in 2019. Healthy life expectancy, which counts only years lived in full health, rose to 62.8 years but remained 0.4 years below its 2019 level, when COVID-19 first struck.

The estimates, which track more than 160 diseases and injuries from 2000 to 2023, show “a global health landscape that is both recovering from the pandemic and continuing to evolve,” WHO said.

“Living longer is one of the great achievements of public health,” said Dr Alain Labrique, director of WHO’s Department of Data, Digital Health, Analytics and AI. “The next challenge is to ensure that those additional years are lived in good health, while health systems are equipped to respond to the changing needs of populations.”

Chronic diseases claim three in four lives; heart disease is still the top killer

Eight of the 10 leading causes of death were noncommunicable diseases (NCDs), led by ischaemic heart disease, stroke and chronic obstructive pulmonary disease (COPD). NCDs, which also include cancers, diabetes and dementia, accounted for 74% of deaths in 2023, up from 58% in 2000.

For the first time, communicable diseases caused fewer than half of all deaths in low-income countries, which WHO called another step in the global epidemiological transition.

Ischaemic heart disease killed about 9.5 million people in 2023, or 16% of the 61 million deaths worldwide, according to a WHO fact sheet published alongside the estimates. Deaths from the disease have risen by 3.0 million since 2000, the largest increase of any cause.

Stroke killed 6.8 million people and COPD 3.6 million. Lower respiratory infections ranked fourth with 2.7 million deaths, back at their 2019 level and once again the deadliest communicable disease.

Alzheimer disease and other dementias were the fifth leading cause of death, killing 2.1 million people. The conditions ranked 19th in 2000, and deaths have tripled since. Women accounted for 66% of dementia deaths.

Deaths from HIV and AIDS fell 62% over the period, pushing the disease from seventh to 22nd.

Diabetes, cancer and mental health conditions on the rise

Diabetes deaths more than doubled to 2.0 million, while lung cancer deaths climbed from 1.1 million to 1.8 million. Kidney diseases rose from 17th to ninth, with deaths up 86%.

Individual risk of ischaemic heart disease increased in WHO’s Western Pacific and South-East Asia regions even as the burden fell in much of the world. The risk of dying from diabetes also rose substantially, particularly in South-East Asia.

The age-standardized rate of healthy life lost to depressive disorders rose by about 20% worldwide between 2019 and 2023, and by nearly 45% for anxiety disorders. WHO said mental health conditions and drug use disorders, alongside diabetes and dementia, were “contributing to a growing and changing burden of disease.”

“The value of these estimates is not only in the numbers themselves,” Labrique said. “By showing how causes of death and disease burden are changing over time and across populations, they give countries evidence to help shape health policies and priorities.”

Chronic diseases climb in low- and middle-income countries

In low-income countries, seven of the 10 leading causes of death in 2023 were still communicable diseases. Lower respiratory infections have been the top killer there since around 2010, except in 2021, with more than 350,000 deaths every year since 2000 and no notable downward trend.

Malaria, tuberculosis and HIV remained in the low-income top 10, though deaths from all three fell significantly. HIV deaths dropped 62%, and diarrhoeal disease deaths roughly halved, sliding from first to fifth. COPD, which ranks in the top 10 in every other income group, did not make the list.

Lower-middle-income countries had a more even mix, with five NCDs, four communicable, maternal, neonatal or nutritional conditions and road injuries among their top 10. Deaths from ischaemic heart disease, stroke and COPD roughly doubled to take the top three places.

Diabetes deaths more than tripled, lifting it from 15th to fifth, while HIV fell from sixth to 20th as deaths dropped about 70%.

Upper-middle-income countries recorded the largest absolute rise in heart disease deaths of any group, nearly 1.8 million. Lung cancer deaths there more than doubled, an increase of 520,000 that is more than three times the combined rise in the other three income groups. It is also the only group where COVID-19 remained in the top 10, ranked 10th, though deaths have fallen 85% since the 2021 peak.

Heart disease deaths fall in rich countries as dementia climbs

High-income countries were the only group where deaths from ischaemic heart disease, stroke and stomach cancer fell, by 18%, 26% and 27% respectively. The two cardiovascular conditions still killed a combined 3.4 million people in 2023.

Dementia deaths in high-income countries nearly quadrupled, lifting the conditions from seventh to third and past lung cancer. Hypertensive heart disease deaths more than doubled, rising from 15th to eighth. WHO attributed rising deaths from most leading causes in rich countries primarily to population ageing.

“Understanding why people die is essential to improving how people live,” WHO said, while cautioning that accurate mortality data remain hard to collect in many low-income countries, where recording systems are often fragmented, incomplete or inconsistent.

“When these data are disaggregated by factors such as age, sex and geographic location, they can reveal important inequalities and help identify where interventions are most urgently needed,” WHO said.

Image Credits: Shahin Khalaji/ Unsplash.

Winter pollutionCrop burning
Punjab, India – Autumn burning of rice crop stubble send smoke across vast areas of northern India.

Rural farm fires and Diwali fireworks likely to trigger pollution emergencies in northern India during late autumn and early winter, despite the rollout of new pollution control measures in the capital city territory.

DELHI, India – As India braces for the winter smog season, Delhi has announced a pollution mitigation plan for the expected peak season – fine-tuned from a bold new series of measures first announced in April.  

However, despite the more science-based, and enforcement-oriented nature of the new plans, as compared to their predecessors, the 23.3 million residents of the National Capital City territory (NCT) may not see significantly lower pollution peaks this year than in past ones – at least in the early part of the winter pollution season.

This is because the new plan has no control over two critical factors that contribute to more than two-thirds of Delhi’s pollution spikes in the cold season: smoke from firecrackers and crop stubble burning drifting in from  farms in neighboring Punjab, Haryana, Rajasthan, and Uttar Pradesh. 

Neighboring rural states lack winter pollution plans

Composite satellite image of air quality over nothern India at the beginning of the 2020 air pollution season shows the Delhi region with “very poor” to “severe” air quality, largely as a result of of crop burning in neighboring Punjab and other rural states.

Meanwhile, none of the neighboring states have matched Delhi’s advance initiative by rolling out a more proactive, evidence-based winter pollution mitigation plan, even though they all contain equally densely populated cities that suffer from equally toxic air.

Delhi’s plan includes curbs on construction, tighter checks on industries and vehicles, better enforcement against open waste burning, higher parking charges, staggered office timings and work-from-home mandates – all of which should bring down at least some of its base pollution load. But only two Delhi suburbs from adjoining states have announced scattered enforcement measures, focusing mainly on stricter compliance with existing restrictions.

This doesn’t augur well for the capital city region, where some 60–65% of winter pollution “comes from or is influenced by surrounding areas,” according to the Delhi Environment Minister Manjinder Singh Sirsa. “Clean air is a shared responsibility,” the minister said on Monday.

On the issue of firecrackers, a two-judge Supreme Court panel Wednesday rejected a total ban on firecrackers around the upcoming Diwali festival (celebrated this year Nov 7), saying that could “hurt the sentiments of people.” Clean Air Activists are already considering launching a campaign saying “better to hurt sentiments than hurt lungs, heart and other organs.”

Crop stubble burning season coincides with weather conditions in ‘perfect storm’ 

Pollution in Delhi peaks in late autumn and early winter when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources.

As the monsoon retreats across northern India, a combination of slowing winds and an earlier-than-usual drop in night temperatures is setting the stage for an early onset of the infamous winter pollution season, when smoke from farm fires drifts across a broad swathe of the Indo-Gangetic plain, hovering over Delhi and neighboring regions. 

Smoke from all the burning gets trapped at ground level due to winter “thermal inversion,” in which warm air acts as a lid, trapping cold, polluted air underneath. 

With the mighty Himalayan range acting as a northern barrier, this toxic smog gets sealed over the Indo-Gangetic plain, where nearly half a billion Indians inhale it. Experts also note that the Super El Niño effect could reduce rain-causing western disturbances this winter, so the temporary benefit of pollutants being washed away by rain showers will also be lost.

Farmers have already started setting fire to paddy stubble standing in the fields after this year’s harvest – a longstanding strategy to prepare their fields quickly for the winter wheat sowing season. 

Satellite data compiled by the Indian Agricultural Research Institute tracked early incidents across multiple states in September 2026 including 25 fires in Punjab, followed by 19 in Uttar Pradesh and isolated incidents in other states. The fires are projected to intensify this year, to coincide with the country’s annual Diwali festival in early November.

A 2024 report by the Indian Institute of Tropical Meteorology indicates that the first winter high-pollution episode happens when stubble fires peak. “This underscores the significant role that stubble burning plays as a source of both primary and secondary pollutants, affecting…distant locations such as Delhi,” the report stated.

And this winter, that first pollution spike from farm fires will likely overlap with Diwali, when half a billion people in Delhi and other parts of northern India are exploding holiday firecrackers.

Punjab unlikely to penalize stubble burning in election year 

The Indo-Gangetic Plain faces particularly poor air quality in the autumn and winter.

India’s Punjab state has historically had the highest crop stubble fires. 

On the books, penalties for burning stubble include a combination of financial fines, police reports, and adverse “red” entries in the farmers’ land revenue records. But with Punjab preparing for its legislative assembly elections in February 2027, the governing  Aam Aadmi Party is unlikely to be very strict in penalizing farmers, who are its base of support in the primarily agrarian state. 

As pre-poll canvassing will be in full swing, other political parties will also likely hold back from pressuring the government on stricter penalties.

While Punjab also offers subsidies to farmers to buy or lease machines to grind rather than burn crop residues, these have proven to be less effective than incentives offered by other states in the form of direct cash benefits. 

“Haryana has done a much better job in administering its subsidies,” a Delhi-based think tank researcher who conducts fieldwork in both states concluded. The Supreme Court has even asked Punjab to take a cue from Haryana’s example of managing its paddy stubble and subsidy management.

Haryana manages its crop residue better

Haryana state, the other major contributor to Delhi smog, has historically managed its crop stubble better than Punjab.

There are two reasons for this: Haryana grows a larger percentage of basmati rice as compared to Punjab; basmati stubble, being more nutritious and digestible, makes better cattle fodder and thus doesn’t need to be burnt, as it gets absorbed. 

Meanwhile, Punjab rice varieties contain more silica in their residue, which makes them less welcome as fodder.

Second, Haryana seems to be doing a better job of incentivizing farmers with both carrot-and-stick measures to better manage residues. This includes subsidies and other direct cash benefits. 

And Haryana farmers have also tended to be more compliant with existing restrictions, perhaps because penalties are also enforced, a senior researcher who has done fieldwork in both states told Health Policy Watch.  

Unfortunately, between the four states surrounding Delhi, smoke from burning fields affects the densely populated capital the most during the post-harvest months. By December, the contribution of farm fires falls to nearly negligible levels while other winter pollution sources become more significant.

 Central Air Quality Commission directs states to use drones to detect fires

The Indian government monitors the burning of crop stubble by farmers in Punjab using satellites that capture a snapshot of the farms at 1:30pm daily. But farmers are evading detection by burning at different times as these satellite images show.

Making matters worse, farmers in Punjab and other northern Indian states have also learned to evade satellite detection by burning late in the evening. Fire counts in the last winter season became unreliable as farmers learned to circumvent the twice-daily (1:30pm and 1:30am) satellite circumnavigation.

Calling stubble-burning prevention an “urgent priority,” the federal government-appointed Commission on Air Quality Management for the first time asked states to use drones to detect farm fires more accurately. If implemented, this measure would at least provide more reliable data through ground-based monitoring and stronger inter-agency coordination.

“Reducing these episodic pollution spikes depends on precise, timely detection of burning events, robust surveillance and coordinated enforcement,” the CAQM said on its website. 

The Commission has also asked the Indian Space Research Organization to differentiate between “high,” “medium” and “low” intensity fires by changing its methodology and models. The satellite models used at present cannot differentiate between the nature of fire, whether it is a large fire or a small, localized fire.

And the Commission has revamped India’s nation-wide pollution emergency response Graded Response Action Plan (GRAP).  Curbs on pollution-generating activities can now be strengthened preemptively, based on dynamic AQI and meteorological forecasts, according to a CAQM announcement on Tuesday.

But this more proactive GRAP system still focuses largely on urban measures for curtailing construction, vehicular movement, diesel generators, and household stoves, sidestepping the critical issues of crop residue fires and firecrackers. 

And CAQM has so far not wielded the full weight of its statutory authorities to rein in the latter two factors. 

Expanding Delhi’s monitoring of urban hot spots

Winter air pollution meeting India Punjab
Members of the Commission for Air Quality Management meet to discuss strategies for mitigating recurrent winter air pollution.

In Delhi, the state government also has announced that it will add 13 new continuous ambient air quality monitoring stations, bringing the city’s total to 60 – enabling  “more granular monitoring of pollution levels and faster identification of local hotspots.”

While an expanded network undeniably strengthens monitoring and data collection, this also does not automatically translate into an actual reduction in emissions – even if a Government statement said it would use the new stations to facilitate “targeted enforcement and faster field-level response.” 

This is particularly true given that capital already has one of the densest air-quality monitoring networks among major global urban centers. This skepticism is compounded by the fact that existing monitors often mysteriously stop working on peak pollution days.

Furthermore, local media and citizens have documented heavy-duty, truck-mounted water sprinklers circling these stations to artificially lower readings. 

Triple-engine government finally focusing on proactive, scientific measures

Winter pollution measures northern India
A Pollution Under Control (PUC) certificate is now required as a measure against winter air pollution.

While the Delhi government’s latest measures mostly echo last year’s with regards to construction, commuting and vehicle travel in a pollution emergency, the series of  announcements by both the central and state governments over the past six months do reflect a new, sharper focus on air pollution science through genuine emissions reduction and a shift to less polluting technologies.

In particular, shifts to EV transport and stricter limits on travel by highly polluting vehicles and stricter enforcement of laws against open waste burning should have a major year-round effect in reducing emissions over time – even if loopholes in the rules remain. 

For instance  – while a Pollution Under Control (PUC) certificate is now being required to allow vehicle owners to purchase petrol or diesel fuel, vehicles still are not tested for emissions of fine particulates, PM 2.5, which are among the most health-harmful air pollution emissions. 

The Delhi government’s commitment to step up “preventive and enforcement measures…with clear timelines, measurable targets and agency-wise accountability,” also reflects the “triple-engine government” force that Prime Minister Narendra Modi’s right-wing Bharatiya Janata Party (BJP) currently wields in control at Delhi local and state levels as well as federal.

So while the Delhi government has undeniably been more proactive in its latest mobility policies – the real test will be better enforcement of the whole suite of emissions strategies, historically a weak point, along with more effective action against crop stubble burning in neighboring states.

Along with that, Delhi still faces big problems with municipal biomass as well as a challenge in stringently enforcing the ban on firecrackers, which generate a massive share of the toxic load during the four peak days of Diwali and are structurally far easier to restrict and contain – if only the political will existed. 

Image Credits: Neil Palmer, @pawanpgupta, Flickr, Britannica, Commission for Air Quality Management, Towards Public Policy.

Military barriers like these have become an omnipresent site around the Israeli-occupied West Bank impeding Palestinian travel, including for health services.

ISRAELI-OCCUPIED WEST BANK – The oxygen mask slipped from three-month-old Ahmad Zaid’s face. He was in his father’s arms, in front of a closed Israeli military gate  blocking the road between  Deir Ammar refugee camp, northwest of Ramallah, where the family lives, and the city of Ramallah, with a hospital the family was desperate to reach.

His father, Maarouf, told Health Policy Watch that he begged the Israeli soldiers at the gate: “My son is dying. Let him through,” he said. They did not open it. Instead, they fired tear gas and stun grenades.

Hours earlier, the baby had simply drunk more milk than usual. It was 5 July, a hot day in summer,  and his father had gone to Ramallah to collect his birth certificate, to get ready for the baby’s first trip to Jericho the next day. Even a trip inside the West Bank requires the name of a newborn to be registered on their parents’ ID documents while crossing numerous Israeli military checkpoints. 

By the afternoon, his mother Yasmine found him unconscious. She rushed him to a local health clinic, where staff tried to revive him, and called an ambulance to take him to hospital in Ramallah. But the road was closed.

“They screamed at us to turn back. They were furious and threatened to shoot,” Zaid’s mother told Health Policy Watch. “When they saw the boy, they paused for a moment, then became even more violent.”

The family had to turn back and take a long dirt track to reach the ambulance. The baby got to the Arab Consultative Hospital just north of Ramallah at 3:20pm. It was too late. He died on the way to hospital.

Military gates block mobility across the West Bank 

West Bank Ambulance Palestine
Paramedics are searched by Israeli soldiers before being allowed to reach the wounded during an Israeli military raid on Jenin, West Bank, September 11, 2026.

The gate closure was not random.  It was part of heightened Israeli security measures. Paradoxically, Palestinians have increasingly been locked into their communities or even their homes in response to a wave of settler violence that has rocked the West Bank in recent weeks, with attacks on Palestinian homes, vehicles, and agricultural lands – while the perpetrators  have gone largely unpunished by Israeli authorities. 

According to an August report from OCHA, the UN’s humanitarian affairs office, there are now more than 900 physical obstacles blocking aid across the West Bank. 

Amid the violence and restrictions on movement, communities  have also been cut off from vital healthcare services, turning treatable health issues into fatal incidents.

Across the West Bank’s 5660 square kilometers, some 82% has remained under direct Israeli security control since the Oslo Accords divided up the occupied territory into Areas A, B, and C in a 1995 agreement – the last ever to be signed between the Palestinian Authority and Israel. 

And movement across the entire territory has now been paralyzed since late July, when Israeli Prime Minister Benjamin Netanyahu ordered a “wide-scale military operation”. 

This was after armed settlers from a new Israeli hilltop outpost attacked the Palestinian village of Tal, in the northern West Bank near Nablus, killing four Palestinians. Two Israelis died in the clashes that followed, one of them a soldier. In a series of reprisals, the army sealed off Nablus and threw a cordon around a broad swathe of towns in the Nablus district- from Deir Ammar to Aqraba, about 60 kilometers to the northeast.

Health fallout of the Qusra siege 

Access to essential medicines and supplies for childbirth remain critically low. WHO and Emirites-donated supplies for childbirth shown here being distributed across the Occupied Palestinian Territory.

Homes in the Ras al-Ain area, about 16 km south of Nablus, have meanwhile been under siege since August 9, this after a  mosque in the village was burned down on 26 July. The Israeli army has turned some of the besieged homes into military positions, Palestinian officials say. 

Then in late August, Israeli settlers stormed the home of a Palestinian American  in the nearby village of Qusra, while its owners were inside – generating headlines that went around the world. 

Qusra, which has fewer than 6,000 residents, also saw its water and power supplies damaged. The diplomatic fall out of the siege has gained wide media attention – less so the health consequences. 

Ruqaya Hassan, 28, lives in Qusra with her husband and two daughters. On 21 August, her younger daughter Hour, not yet two and a half, came down with a cold, a high fever and vomiting. “The family’s medicine was running low. The nearest doctor was not far, but the roads were sealed,” she told Health Policy Watch.

An ambulance’s first attempt to reach the house failed. It got through the next day, and Ruqaya left with her sick daughter:  “I thought I would be back soon. I was not,” she said. Two days later, she tried to return home and found she could not: “The Israeli army had entered the area and turned my house into a military position.”

She now stays temporarily with her two daughters at her brother-in-law’s house nearby, unable to close the few dozen metres that separate her from the relatives still trapped inside the besieged area. Her husband, Yousef, remained inside.

As the recent OCHA report notes,  three families have remained been trapped in Qusra since 9 August, after a new settler outpost was built next to their homes. It was only after repeated attempts that aid workers managed to bring the families some food, water, baby formula and medicine – but supplies of all items remain precarious and subject to military approval. On 4 September, about 100 activists who arrived with supplies were first blocked by the army, which declared Qusra a closed military zone, then let through, only to be detained on their way out for violating it.

Too late at health clinic for newborn  

On 27 July, the same day Nablus was sealed off, 34-year-old Rana Rasheed, six months pregnant, suddenly went into premature labor. An ambulance was called to take her to Rafidia Surgical Hospital in the city nearby.

“I was in severe pain, like labour pains, and felt extremely exhausted,” Rasheed told Health Policy Watch. 

What should have been a short trip of nearly 25 minutes became 90 minutes of driving between checkpoints and dirt tracks, as the driver found gate after gate closed before reaching the Awarta checkpoint.

By then, Rana’s condition had turned critical. She began to lose the baby, and bled heavily. “She was in a very critical condition,” Sabreen Attallah, the nurse and midwife travelling with her, told Health Policy Watch. “I’ve worked since 2014, and I had never seen bleeding like that before.”

At the checkpoint, soldiers ordered the driver to turn off the siren and open the ambulance doors, then raised their rifles at Attallah as she tried to explain in English that the patient could die. 

“They screamed at me: ‘shut up!’” she said. She had no choice but to deliver the baby moments before reaching the checkpoint. 

The baby did not survive. 

“I felt profound grief when they told me I had lost my baby,” Rasheed said. “I had been choosing names, getting ready to buy his clothes.”

Stillborn baby in Aqraba 

A similar horror story played out on 27 July in Aqraba, a town south of Nablus.

When Ibtisam Bani Jame, 28, went into labor, the road closures meant no ambulance could reach her either. 

“I felt like I had lost hope. I kept thinking I might lose my baby because of a closed road, not my medical condition,” she told Health Policy Watch.

After more than four hours in labour, the family went to the only place they could reach: a small clinic called Dar al-Hikma, never built for deliveries. It had no medicine to stop bleeding, no fetal heart monitor, no incubator, no spare blood.

The baby was stillborn. 

Who decides who gets treated? 

Map of West Bank
Occupied Palestinian Territory: West Bank including East Jerusalem & Gaza.  [Map Sources: ESRI, OCHA, UNGIS & for Areas A, B, C, OCHA: “The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries.”]
Qaryut, Deir Ammar, Aqraba and Qusra look like separate dots on a map, but their fate is  linked. 

A soldier’s split-second decision to open a gate or leave it shut to families seeking emergency treatment in a nearby hospital in one of the larger West Bank cities in “Area A” under Palestinian Authority control, like Nablus, Bethlehem, Ramallah, Hebron, or Jenin, can be random, arbitrary and lead to life-and-death consequences. 

Meanwhile, patients seeking more specialized treatment in the most sophisticated Palestinian hospitals of East Jerusalem, as well as in Israel, face a range of bureaucratic hurdles.  

They must obtain an official permit from Israel’s Civil Administration – something that cannot usually be had quickly. .

Amos Zwarts is the Israeli official in charge of health coordination for the West Bank.  His  office handles requests to move Palestinian patients into Palestinian East Jerusalem and Israeli hospitals for treatment, working with the Palestinian Health Ministry and its hospitals and health clinics. 

Approval of a patient’s passage is, “the result of coordination among several bodies,” Zwarts told Health Policy Watch.

“The decision is not subject to a unilateral decision by our office alone,” Zwarts added.  “Requests can come through an app, the Palestinian civil affairs ministry, or liaison officers, before being processed by a system that weighs both civilian and security concerns.”

Approval rates for entry into East Jerusalem or Israeli hospitals fell sharply right after the  war in Gaza began in October 2023, from 82% in 2022 to 56% in 2024, and while they have since recovered somewhat, they have yet to reach their pre-war rates.

According to WHO data, while about 51,444 permit requests were made in the first half of 2026,  more than 22% were not approved in time for appropriate treatment. 

No single body takes responsibility for the thousands of rejected or delayed requests -or their human health impacts. 

Empty medicine shelves, doctors on strike 

Violence, economic distress and funding cuts leave nearly a million people in the West Bank facing severe food insecurity, according to the WFP.
Violence, economic distress and funding cuts leave nearly a million people in the West Bank facing severe food insecurity and without access to essential medicines, according to the World Food Programme.

Behind the siege tactics and the surge in settler lies a deeper, structural crisis in West Bank healthcare, one that predates this summer and will outlast it – a health budget starved since May 2025 by the loss of Palestinian tax revenues.

The revenues have been withheld by Israel’s far-right Finance Minister Bezalel Smotrich  as part of what the liberal Israeli daily Ha’aretz described in one recent editorial as a “Slow Motion Execution of the West Bank Health System,”

To date, the unpaid bill amounts to some $5.7 billion and counting, according to the PA’s own finance ministry.

The budget crisis means that even patients who are lucky enough to reach a hospital in one of the West Bank’s major cities may find there are no medicines to treat them.

In June 2026, the Palestinian Authority Health Ministry said 180 of 520 essential medicines were out of stock on the West Bank. So were 50 of 97 cancer drugs along with medical supplies and laboratory materials.

West Bank medicine shortages threaten thousands of cancer and dialysis patients 

Palestinian healthcare workers have little supplies to work with as they also go without pay – and are often threatened with imprisonment. Continuation of care for chronic diseases is threatened by attacks and budget crises.

The ministry said the shortage threatened more than 4,000 cancer patients and thousands more on dialysis, and had delayed more than 11,000 operations since the start of the year.

The same budget crisis has emptied West Bank hospitals of staff, as well. 

Physicians hadn’t been paid in full since October 2023, when Hamas launched its surprise incursion into Israeli communities on its periphery, killing about 1200 people and taking 251 hostages -triggering a massive Israeli military onslaught that killed over 70,000 Gazans. 

The ensuing two years of war displaced most of Gaza’s population, damaged or destroyed most of the enclave’s hospitals and health clinics and  left tens of thousands of people with permanent injuries and amputations.  

The simultaneous halt to funds flowing to the West Bank’s Palestinian Authority’s health system has been far less visible on the television screens of the world or in the reports of humanitarian organizations  – but almost as insidious. 

In May, the Palestinian Doctors Association launched a partial strike across all PA-run hospitals and clinics over unpaid salaries. By early May, hundreds of clinics had shuttered, and nurses’ unions cut service hours over the same crisis.

Palestinian Health Minister Dr Majed Abu Ramadan told Health Policy Watch the financial crisis is hurting the ministry’s ability to do its job, at a time when demand for care keeps rising, both inside government hospitals and through referrals to private and foreign hospitals.

“Patients rely on referrals when treatment isn’t available in government hospitals. That makes steady funding key to getting them care on time,” he said.

Unpaid bills can make hospitals and clinics reluctant to accept referred patients, or slow down approvals, Abu Ramadan said.

“A delay in a referral isn’t just paperwork. For some patients, it means treatment they can’t get anywhere else arrives too late,” he said.

Health workers detained 

Access to healthcare is routinely impeded by barriers such as these lining East Jerusalem.

Arrests of medical staff have also depleted the ranks of some of the most public-minded professionals.

At dawn on 22 June, Israeli forces, backed by border police, arrested Dr Mazen al-Rantisi, 71, from his home in Ramallah. His family was not told why. Known for decades as the “doctor of the poor,” al-Rantisi chairs a committee overseeing clinics in remote villages. In August, his lawyer later told the Israeli newspaper Haaretz that he had been denied his medication in Ofer prison, and that staff refused to let him see a doctor. The Israel Prison Service said the claims were untrue.

Dr Khaled Ayyash, 63, was detained on 24 June and later released. Jamila Yacoub Abu Dahou, a Palestinian-Australian public health expert, 66, was arrested in July, accused of funnelling money to the Union of Health Work Committees, a health workers’ group that Israel banned in 2020. She was released after 23 days.

The most recent case is Dr Dima Mohammad Amin Barakat, 54, an obstetrician-gynaecologist arrested on 18 August. No reason was given. She later suffered a medical emergency in detention including a heart procedure, but a military court still  extended her detention. 

Medical Aid for Palestinians said her detention came amid “a wider and growing pattern of attacks, detention and intimidation targeting Palestinian healthcare workers.”

A Palestinian rights network said the arrests fit a pattern of targeting doctors and health institutions, though it stopped short of saying every case shares the same motive. 

WHO has so far recorded 25 arrests or detentions of health workers or patients in the West Bank so far this year, through the end of July. That figure is part of a broader tally of 98 attacks on health care documented across the West Bank over the first seven months of this year, which left 3 people dead and 87 injured. Some 83 health transport vehicles and 11 health facilities were also damaged in the process – with attacks alone nearly quintupling in July, from 8 in June to 37.  

Aseel Mafarjeh is a West Bank-based journalist covering the politics of the Israeli-Palestinian conflict, including settler violence, Israeli military operations and raids on refugee camps, Palestinian Authority governance and financial crises, and the impact of movement restrictions on daily life. Her work has appeared in Al Jazeera English, TRT World, +972 Magazine, The New Arab, and Mondoweiss.  This article is published in collaboration with Egab.

Image Credits: Aseel Mafarjeh/HPW, Health Policy Watch , WHO oPT, ESRI, OCHA, UNGIS & for Areas A, B, C, OCHA and Wikipedia Commons, WFP/Claire Nevill, BTSelem.