Countering chemical, biological, radiological, and nuclear incidents through intersectoral cooperation: an interview with Cornelius Bartels
WHO appeals for protection of the health system from further attacks and degradation of its capacity
Once again, nowhere is safe in Gaza. WHO is gravely concerned about the resumption of hostilities, including heavy bombardment in Gaza, and reiterates its appeal to Israel to take every possible measure to protect civilians and civilian infrastructure, including hospitals, as per the laws of war.
We have seen what happened in northern Gaza. This cannot be the blueprint for the south. Gaza cannot afford to lose another hospital as health needs continue to soar.
As more civilians in southern Gaza receive immediate evacuation orders and are forced to move, more people are being concentrated into smaller areas, while the remaining hospitals in those areas run without sufficient fuel, medicines, food, water, or protection of health workers.
WHO and other partners are less able to provide support, given dwindling access to our supplies or any assurance of safety when we move supplies or staff.
This morning WHO was contacted with advice to move as many medical supplies as possible from a warehouse in Gaza, situated in an area ordered to be evacuated. Access to storage could become challenging over the coming days due to ground operations.
Intensifying military ground operations in southern Gaza, particularly in Khan Younis, are likely to cut thousands off from health care – especially from accessing Nasser Medical Complex and European Gaza Hospital, the two main hospitals in southern Gaza – as the number of wounded and sick increases.
Lack of access would also limit WHO’s ability to deliver aid to these hospitals.
About 1.9 million people, nearly 80% of Gaza's population, are estimated to be internally displaced. Recent evacuation orders cover 20% of Khan Younis and localities east of Khan Younis, which prior to the hostilities were home to nearly 117 000 and 352 000 people, respectively.
In less than 60 days, the number of functioning hospitals has dropped from 36 to 18. Of these, three are only providing basic first aid, while the remaining hospitals are delivering only partial services. Those able to admit patients are delivering services well over their intended capacities, with some treating two to three times as many patients as they were designed for. The 12 hospitals that are still operational in the south are now the backbone of the health system.
On a recent visit to Nasser Medical Complex in Khan Younis, the WHO team described the situation inside as catastrophic, with the building and hospital grounds grossly overcrowded with patients and displaced people seeking shelter. The emergency ward is overflowing with patients. There is a shortage of health workers compared to the overwhelming needs. Those who are available have been working non-stop and are exhausted. Many patients are being treated on the floor. Bed capacity has been overwhelmed. Patients and families sheltering at the hospital are scared for their security.
Disease surveillance systems are hampered, but syndromic surveillance has noted increases in infectious diseases, including acute respiratory infections, scabies, jaundice, diarrhoea, and bloody diarrhoea. Shelters in the south are also reporting cases of acute jaundice syndrome, a worrisome signal of hepatitis.
From 7 October to 28 November, WHO recorded an unprecedented number of attacks on health care: 203 attacks on hospitals, ambulances, medical supplies, and the detention of health-care workers. This is unacceptable. There are means to protect civilians and civilian infrastructure, and they should be instituted.
The only viable solution is a sustained ceasefire.
Note to editors:
On 3 December alone, 349 people were killed and 750 injured according to reports from the Ministry of Health.
According to the Ministry of Health, the bed occupancy rate at operational hospitals stands at 171%, while in the intensive care units the occupancy rate is up to 221%.
Currently, there are 1000 patients and thousands of people sheltering at the 350-bed Nasser Medical Complex, and 1000 patients and an estimated 70 000 people sheltering at the 370-bed European Gaza Hospital. Both hospitals are three times beyond their capacity.
As of 3 December, per Ministry of Health reports, more than 15 899 people have died, over two-thirds of them women and children. An additional 42 003 people, also mostly women and children, have been injured.
It is with immense sadness that I learned today of the passing of our dear friend, Dr Carissa F. Etienne.
Dr Etienne, a native of Dominica, served as Director of the Pan American Health Organization and as WHO Regional Director for the Americas from 2013 to 2023, during which the Americas made impressive progress towards universal health coverage, and against both communicable and noncommunicable diseases.
Dr Etienne also demonstrated exemplary leadership in response to the COVID-19 pandemic and to other health emergencies.
As a valued member of WHO’s senior leadership, Dr Etienne provided trusted advice and support to the Organization’s mission to expand access to health services for people in the Americas and globally.
Dr Etienne also served in multiple other roles for WHO, including as Assistant Director-General for Health Systems and Services at WHO headquarters in Geneva, Switzerland.
Her dedication to public health and significant contributions to WHO leave a legacy in the health of the people of Dominica, the Americas and the world.
On behalf of WHO, I extend our heartfelt condolences to Dr Etienne’s family, friends, and colleagues.
She will be greatly missed.
41 funders, partners endorse new guiding principles for financing climate and health solutions to protect health
ECDC, Europol, NCDC and Georgia’s Ministry of Internal Affairs organises training on biorisk awareness and mitigation
For World AIDS Day, marked on 1 December, the World Health Organization (WHO) is joining international partners to acknowledge the resilience, dedication and innovation exemplified by community leaders and organizations in the response to the HIV epidemic.
From fighting stigma and discrimination, to advocating for access to affordable interventions, and community led services that put people with lived experience at the centre, communities have shaped the HIV response for decades.
“People living with or affected by HIV have left an indelible mark on the world with their activism,” said Dr Tedros. “The affected communities who fought for tools to prevent, test and treat HIV enabled 30 million people to access antiretroviral therapy, and helped to avert an unknowable number of infections. We stand together with communities to help end AIDS as a public health threat by 2030.”
Several decades of investments and learnings from the HIV epidemic have catalysed broader advancements in global health and national health systems. The response to HIV strengthened healthcare systems and increased access to services beyond HIV testing and treatment. Investments and infrastructure from the HIV response enabled strong and swift responses to many diseases including COVID-19 and mpox.
Globally, 9.2 million people do not have access to the HIV treatment that they need. Each day 1700 lives are lost from HIV-related causes, and 3500 people are infected, with many not knowing their status or having access to treatment.
Innovations in HIV tools, such a powerful once a day pill for HIV treatment and accessible viral load testing, have enabled significant progress. The fact that people living with HIV, who take their HIV treatment as prescribed and have no virus detectable in their blood, have zero risk of transmitting HIV to their sexual partners, is just one such example. This was the result of years of advocacy and investment, and is a reminder that the target of ending AIDS as a public health threat by 2030 is achievable, provided there is sufficient political will and sustained investments.
Funding, criminalization, and limitations placed on the roles of community champions hinder the progress achieved by community leaders and slow global progress to ending AIDS as a public health threat. Many communities, such as key populations of men who have sex with men, transgender people, sex workers, people who use drugs, and adolescents, still lack access to the prevention, treatment, and care services that they need and deserve. These inequalities continue to drive the uneven progress on HIV.
With less than 7 years to reach this goal, there is still an urgent need for continued funding to HIV programmes so that community leaders can continue reaching those affected. These efforts are essential to close the gaps in diagnosis and treatment for children living with HIV, and help all countries move closer to the 95-95-95 targets, which aim for 95% of people living with HIV knowing their status, 95% of those diagnosed receiving antiretroviral therapy and 95% of those on treatment having suppressed viral loads. WHO will continue to work with partners and call on leaders to prioritize the needs of affected populations.
“We call for global solidarity with communities today and every day,” said Dr Meg Doherty, WHO Director of Global HIV, Hepatitis, STI Programmes. “The leadership of affected communities has been vital to moving forward the HIV response, despite the legal, economic and social barriers they face.”
Partnership with people living with and affected by HIV is critical to the sustainability and ultimate success of the HIV response. WHO stands with global partners to applaud the role of the communities in closing the testing, treatment and care gaps for those left behind and in driving progress towards ending AIDS as a global public health threat.
No time to waste: to tackle its HIV epidemic, the European region must urgently increase testing and address persistent stigma
In a full day of meetings on 20 November, WHO leaders and a Canadian government delegation reflected on their decades-long cooperation and sought to sharpen their strategic engagement on shared global health priorities, notably, health-systems strengthening, universal health coverage, embedding gender equality, equity and rights across WHO’s programmes, sustainable financing, health emergencies and pandemic preparedness.
The delegation was led by Mr Jean-Bernard Parenteau, Director General, Health and Nutrition Bureau of Global Affairs Canada and Patricia McCullagh, Deputy Permanent Representative of Canada to the United Nations in Geneva.
WHO representatives from across the Organization gave presentations on health emergencies, sexual and reproductive health and research; gender, equity and rights; primary health care as a foundation for universal health coverage; vaccine manufacturing; the International Health Regulations; and the work of the Intergovernmental Negotiating Body, which is drafting a pandemic treaty for consideration by the World Health Assembly next May.
Canada is currently the eighth largest contributor to WHO, and the fifth largest Member State contributor. For the 2022-23 biennium, Canada has contributed nearly US$ 175 million.
“Canada remains committed to the WHO as the centre of the global health ecosystem and deeply appreciates its pivotal role in helping the world prevent, prepare for, and respond to health emergencies, including the COVID-19 pandemic,” Mr Parenteau said. “As we renew our focus on primary health care and equitable and resilient health systems, we must take a gender-responsive, human rights and equity-based approach, including to advance sexual and reproductive health and rights for all. We welcome WHO’s leadership in these areas, and to continued collaboration.”
WHO Health Emergencies Programme Executive Director Dr Mike Ryan commended Canada for its support for WHO, and to emergencies in particular. Canada is the fourth-largest contributor to WHO’s Contingency Fund for Emergencies, having provided US$ 8.3 million since 2015.
He said one of the vulnerabilities highlighted by the COVID-19 pandemic was the lack of access to life-saving medical countermeasures faced by many countries, and that collaboration with Canada and other global health leaders on timely and equitable access to medical countermeasures against pandemic threats is critical.
“We look forward to continuing this crucial dialogue with Canada, committing to equity and solidarity,” Dr Ryan said. “Together, we can ensure that no one is left behind when the next pandemic strikes.”
The delegation also met with Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course, who expressed WHO’s appreciation for Canada’s active, constructive participation in the ongoing development of WHO’s 14th General Programme of Work. He recognized the country’s support for strengthening universal health care, maternal and child health, and sexual and reproductive health and rights, as well as Canada’s important role in the Universal Health Coverage Partnership.
Patricia McCullagh, Deputy Permanent Representative of Canada to the United Nations in Geneva and Jean-Bernard Parenteau, Director General, Health and Nutrition Bureau of Global Affairs Canada, led a delegation to WHO headquarters on 20 November. ©WHO/Bernard Dizier
In the run-up to COP28, the World Health Organization (WHO) together with the global health community, is raising its voice to ensure that the impact of climate change on health takes centre stage in the negotiations. It is imperative to broaden the focus to human health in global discussions, leaving no room for excuses, and compelling negotiators to recognize that they bear the responsibility for the well-being of our most invaluable asset: the health of populations worldwide.
"Prioritizing health is not just a choice; it is the foundation of resilient societies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Leaders must deliver in Dubai, providing the strong health outcomes their peoples expect and their economies urgently need. We must change the conversation and demonstrate the massive benefits of bolder climate action on our health and well-being.”
The extreme weather events around the world in recent months offer a terrifying glimpse of what lies ahead in a rapidly heating world. The IPCC report says about 3.5 billion people – nearly half of humanity – live in areas highly vulnerable to climate change. Heat-related deaths among those aged over 65 years have risen by 70% worldwide in two decades, according to WHO’s figures. Only a dramatic and dedicated effort to limit warming to 1.5 °C will prevent a future much worse than what we see now.
Increasingly frequent and severe extreme weather events, such as droughts, floods and heatwaves, will also strain healthcare infrastructure. Last year's floods in Pakistan displaced 8 million people and affected 33 million overall. Forecasts from the World Bank indicate that without bold and immediate action, climate change could displace approximately 216 million people by 2050.
As the climate crisis jeopardizes lives and livelihoods, global food systems struggle to sustain a growing population, and compromised water sources compound the challenges. In parallel, climate change is catalyzing a surge in infectious diseases like dengue and cholera, endangering millions. Now is the time for decisive and collaborative action to mitigate the health impacts of the climate crisis and build a sustainable future for all.
As climate change poses an unprecedented challenge to health systems worldwide, it is also imperative that we strengthen our systems to be resilient, low carbon and sustainable. Failure to act swiftly will render health systems worldwide vulnerable to the overwhelming impacts of climate change.
Climate change is not a distant threat; it is a present danger affecting our health on multiple fronts. The health community asserts that climate change is already affecting our health, contributing to the spread of infectious diseases and vector-borne illnesses. There is an urgent need for negotiators to comprehend that climate change is a direct threat to global health that can no longer be ignored or downplayed.
Adapting our health systems means upgrading key interventions such as vector control, epidemiological surveillance, and access to safe water and sanitation. Additionally, the training of health staff is crucial, and support is needed to align health systems with the guidance included in WHO's operational framework for building climate resilient and low carbon health systems.
To reduce the negative impact on health, the health community stresses the importance of reducing and stopping emissions. According to WHO, 7 million premature deaths annually are attributed to air pollution. Urgent mitigation measures, including transitioning to clean energy sources, are necessary to protect human health and create sustainable outcomes.
The health community recognizes the role health systems play in contributing to emissions, and advocates for greening the health sector. This involves decarbonizing health systems, digitalizing medicine and implementing sustainable practices in hospitals and health-care facilities to significantly reduce the 5% global emissions attributed to the health sector.
Over 1 billion people worldwide are served by health-care facilities with unreliable electricity or no electricity at all. For low-income countries lacking access to electricity, the health community calls for an acceleration of access to clean energy. WHO is working with partners to accelerate electrification of health-care facilities through renewable energies and to harmonize medical supplies and lead a transformative change towards cleaner energy sources, better services and reduced reliance on diesel and gas.Recognizing the financial disparity in health systems
Acknowledging the financial gap in health systems, the health community calls for increased financing from new sources. The plea is to divest from and end subsidies for fossil fuels, and to mobilize new funds to support health systems in coping with climate change.
The WHO-led Alliance for Transformative Action on Climate and Health (ATACH) is dedicated to realizing the goals set at COP26 by leveraging the collective influence of WHO Member States and stakeholders to advance climate-resilient health systems. ATACH also focuses on identifying financing needs.
With the health sector grappling with unprecedented challenges, it is imperative to address the glaring disparity in financial support. Currently, the sector receives a mere 0.5% of global climate financing. To effectively confront the many challenges ahead – from the ongoing global health crisis to the ever-evolving landscape of medical research and technological advancements – a substantial increase in resources is not only warranted but essential. By multiplying financial support, we can strengthen the sector's ability to innovate, adapt and provide optimal care, ensuring a resilient healthcare infrastructure for the challenges of today and the uncertainties of tomorrow.WHO urgent call for climate and health action at COP28
As the world unites at COP28, the health community calls for decisive action. We urge negotiators to recognize that climate action is health action, and failure to address this reality will have profound consequences for the well-being of current and future generations.
The WHO call to action unites the health community in demanding a commitment to building resilient health systems, reducing emissions, and prioritizing health. The first-ever Health Day is set to elevate the global profile of the climate and health nexus and integrate health within the climate change agenda.Health Day and Ministerial session
The first-ever Health Day is set to elevate the global profile of the climate and health nexus and integrate health within the climate change agenda. For the very first time, a record number of health ministers will be attending COP28. The presence of a significant number of health ministers underscores the commitment to prioritize health in the context of climate discussions and reinforces our commitment to creating a healthier and more sustainable future. The Ministerial session promises to amplify the urgency for action by bringing together global leaders to implement sustainable solutions. This historic gathering will focus on addressing the crucial intersection of health and climate change.
The legacy of COP 28 will be a commitment to a healthier planet, where the health arguments for climate action are not just heard but lead to tangible results.
On 22 November, in cooperation with the Palestine Red Crescent Society, WHO participated in another joint-UN mission to transfer 151 patients, relatives and health workers accompanying them from Al-Shifa hospital in northern Gaza. The mission was undertaken following specific requests from health authorities and hospital officials in Gaza.
During this mission, the team transferred 73 severely ill or injured patients, including 18 dialysis patients; 26 patients with serious spinal injuries; 8 patients with severe chronic conditions; two in need of critical care; and 19 patients in wheelchairs. The patients were transported in 14 ambulances supplied and staffed by the Palestine Red Crescent Society, and two buses, with 8 health workers and 70 family members accompanying them.
This was a high-risk mission, as intense fighting and shelling continued in proximity of Al-Shifa hospital.
It took 20 hours for the team to complete the evacuation, including 6 hours at a checkpoint where the team and patients were screened by the Israeli Defense Force. This was despite an initial agreement to only screen participants at the origination point in Al-Shifa Hospital.
The screening process involved checks on the patients, their relatives, and the personnel; these included elderly, children and severely ill patients. Three medical personnel from the Palestine Red Crescent Society and three from the Ministry of Health were detained.
After 6 hours at the security checkpoint, the convoy proceeded as the condition of some of patients was already deteriorating. Patients reached their final destination late at night.
Most of the patients were ultimately transferred to the European Gaza Hospital, with the dialysis patients admitted to Al Najjar Hospital. Both facilities are in the south of Gaza.
WHO is extremely concerned about the safety of the estimated 100 patients and health workers remaining at Al-Shifa. Due to the limited time that the mission members were able to spend in the hospital and the urgency of moving the most critical, it was difficult to determine exactly how many remain.
Two of the six detained health workers have reportedly been released. We do not have information about the well-being of the four remaining health staff, including the director of Al-Shifa hospital. WHO calls for their legal and human rights to be fully observed during their detention.
This and other evacuations were requested by health authorities, health workers and patients, and became necessary as Al-Shifa Hospital is no longer able to function due to lack of water, fuel, medical supplies, food, and staff, and recent military incursions.
Also on 21 November, WHO and partners undertook a mission to Al-Ahli Hospital in northern Gaza to assess medical priorities. Al-Ahli, which is one of the only functional hospitals in the north, must be urgently and regularly supplied with fuel, water, food and medical supplies to ensure the continuity of care. Today, 22 patients along with 19 companions arrived at the European Gaza hospital, in the transfer mission undertaken with the Palestine Red Crescent Society, following the assessement mission. WHO again asks all relevant authorities to ensure that the medical evacuations that WHO has been requested to assist in can proceed safely, under agreed procedures, without endangering the lives of patients. Ultimately, the safety, security and evacuation decisions rest with the relevant authorities.