Ukrainian Red Cross teams have delivered over 3,300 hot meals to Kyiv residents at support points around the city. Credit: Red Cross

By Ed Holt
BRATISLAVA, Feb 24 2026 (IPS)

“We have a saying here in Ukraine now – ‘young people meet at their friends’ funerals rather than at weddings.’ It’s sad, but very true.”

As Russia’s full-scale invasion of her country moves into its fifth year, Iryna Yakova, 29, is looking back at how her life has changed over the past four years.

Speaking from Lviv, the western Ukrainian city where she lives, she tells IPS that her “values and attitude towards life” have changed. “Material things become unimportant when your loved ones or friends are in danger,” she says. She has also developed a keen sense of her national identity and an empathy for the suffering of her fellow Ukrainians.

“During the full-scale invasion, I realised that all of Ukraine is my home. I cry for people who were killed by a missile in Kyiv while they were sleeping at night. Even though I didn’t know them, it hurts me because they are Ukrainians. It also pains me to see children growing up without their parents because their parents are at the front. The war has intensified my sense of empathy and belonging.”

Her mental health has suffered. She says anxiety is ever-present in her life.

But what she returns to often as she answers questions about how her life is today compared to before the war is the loss she, and others, have experienced.

“What I miss most [from my life before the full-scale invasion] are the people who have been killed in the war. I have lost friends, acquaintances, and relatives. Nothing compares to human loss. The hardest thing I have had to deal with during this war is going to the funerals of friends — people you used to go to parties with, travel with, study with,” she says.

The human cost of Russia’s full-scale invasion of Ukraine has been enormous – Ukraine’s government does not officially give figures for military casualties, but it has been estimated they could be up to 600,000 (Russian military casualties are thought to be more than twice that amount).

But the scale of civilian casualties has been huge, too. According to UN bodies, more than 15,000 civilians have been killed and over 41,000 injured in Ukraine since the start of the invasion on February 24, 2022.

Worryingly, as Ukraine marks the fourth anniversary of the start of the war, research suggests there has been a sharp increase in civilian casualties over the last year.

Data from Action on Armed Violence (AOAV), released earlier this month, showed civilian casualties in Ukraine increased by 26 percent in 2025 compared with 2024, despite there being a 6 percent drop in the number of injurious explosive weapon incidents recorded nationwide.

In Kyiv, response efforts continue amid attacks on energy infrastructure and severe cold. The Ukrainian Red Cross is supporting warming centres around the clock, providing people with a safe place to warm up, receive assistance, and feel cared for during difficult conditions. Credit: Red Cross

The group said its data showed a worrying shift in the character of the conflict – the average number of civilians killed or injured per incident in Ukraine rose 33 percent over the year, with a total of 2,248 civilians reported killed (an 11 percent rise) and 12,493 injured (a 28 percent rise) by explosive violence.

This suggests that explosive weapons are being used by Russia in Ukraine in ways that generate greater civilian impact, whether through more drone strikes, heavier munitions, specific targeting choices of populated areas, or repeated strikes on urban infrastructure, the group said.

Nearly seven in ten civilian casualties recorded in AOAV data occurred in residential neighbourhoods, up from just over four in ten in 2024.

Niamh Gillen, a researcher at AOAV, told IPS it was impossible to definitively say that Russian forces were deliberately targeting Ukrainian civilians, but that “the data speaks for itself.”

“It shows that civilian areas are being attacked, that the attacks are occurring within civilian areas like hospitals, schools, cities, towns. In general, in areas where civilians are heavily concentrated, like cities and towns, villages, anywhere like that, if you’re using an explosive weapon with wide area impacts, then you’re likely to harm more civilians,” she said.

On top of the deaths and destruction Russian attacks have caused, they have also led to massive displacement. It is thought that at least 3.4 million people are internally displaced in the country. This has put massive pressure not just on the displaced themselves, but also on host communities and services.

People’s physical health has deteriorated in such conditions – the World Health Organisation (WHO) has said that more than two-thirds of the population have reported a worsening of their health since the start of the invasion.

But the harm caused by these attacks is far from just physical. Mental health professionals in the country, as well as international bodies including the WHO, have warned of a mental health crisis in Ukraine, with possibly up to 10 million people suffering with mental health problems.

IPS spoke to scores of people in cities and towns across Ukraine about how the war had affected their mental health. Many spoke of experiencing anxiety, sometimes permanently to some level, which could be intensified at any moment by the frequent sound of air raid sirens warning of an attack, or for those closer to frontlines, the sounds of explosions and bombings.

“What affects my mental health on a daily basis are the constant nighttime drone and missile attacks. Because of them, it is impossible to relax or get proper rest, as reaching a shelter for safety is essential, even at night,” Mihail*, a teenager who lives in the Kyiv region, told IPS.

The situation for many Ukrainians has acutely worsened this winter. In what has been one of the coldest winters the country has seen for many years, Russian forces have repeatedly attacked Ukraine’s energy infrastructure, resulting in massive, widespread power outages. Thermal heating facilities have also been destroyed in targeted attacks.

As temperatures have plunged to as low as minus 30 degrees Celsius on some occasions, millions of people have been left freezing in their homes.

Jaime Wah, Deputy Head of Delegation with the International Federation of Red Cross and Red Crescent Societies (IFRC) in Ukraine, said people were suffering desperately in the cold.

“Some nights have been very unbearable. There is no escape from the cold. When you leave your apartment, it’s cold. Sometimes people have been joking that it’s warmer inside a fridge than inside their apartment. I’ve been here for over four years now, and it’s been the worst winter,” she told IPS.

Humanitarian organisations, including the Ukrainian Red Cross, and state emergency services have set up emergency heating points in cities and towns where people can keep warm, recharge devices and get food.

But Wah said while this has become a humanitarian crisis, it is one of just many crises Ukrainians are battling.

“In frontline regions, there are communities that are under evacuation orders, and some communities have essentially had most of their resources cut off. Family ties are quite strained – mental health needs are also immense, not only in the frontline regions but across Ukraine,” she said.

“There are lots of repairs to homes that are needed, not to mention the energy crisis, which is a humanitarian crisis… with no heating and no electricity, just the day-to-day things – just even heating your food becomes a problem. A lot of families are having to spend more time outside their homes, having to spend more money. On top of that, the cost of living has increased. These are some of the real, tangible situations that people in Ukraine are facing now,” she added.

Amid these problems, many Ukrainians admit that they are exhausted after four years of war.

But among the many people IPS spoke to on the eve of the fourth anniversary of the war, there was a widespread, although certainly not universal, determination to not give up.

“I feel a sense of responsibility. I do not have the right to give up, because many people have died so that I could have the chance to live. Of course, there is exhaustion, but, unlike those in the military, a civilian like me has time to rest and reset,” said Iryna.

For many, such resilience is born out of a desire not just for them and their country to survive what they see as Russia’s attempt to destroy them as an independent state and nation, but also a hope that, ultimately, there will be some justice served for what has been done to them.

The Russian military and authorities have repeatedly been accused of war crimes, crimes against humanity, breaches of international humanitarian law, as well as genocide, during the invasion of Ukraine.

The sheer volume of alleged crimes – at least 180,000 war crimes have been registered by Ukraine’s Prosecutor General – and the constraints of documenting, investigating and prosecuting during an ongoing conflict mean that bringing those behind them to justice was never expected to be easy. Only over 100 people have been prosecuted in Ukraine so far for crimes during the invasion.

But there are fears that international bodies such as the International Criminal Court (ICC), which has issued an arrest warrant for, among others, Russian President Vladimir Putin over alleged war crimes, could be rendered increasingly toothless in their ability to ever prosecute major figures who ordered such crimes because world leaders, such as US President Donald Trump, are no longer interested in upholding international justice for war crimes.

“I truly hope that the war will end very soon and that all war criminals will be brought to justice. However, what I see happening right now is the opposite: while institutions like the UN are unable to punish Russia, people are starting to forget about its war crimes. Countries are gradually lifting sanctions,” said Mihail.

“For example, Russian athletes are going to be able to take part in the Paralympics this year. As a result, people who committed war crimes just months or years ago can now take part in one of the world’s biggest sporting events. So we need to act – by refusing to normalise aggression, keeping sanctions firm and, most importantly, remembering about war.”

Others, though, are more hopeful.

“There is no doubt among Ukrainians that war criminals can be brought to justice,” Oleh Martynenko, an expert at the Ukrainian NGO Center for Civil Liberties, which documents war crimes, told IPS.

“This is evidenced by the participation of Ukrainians in international missions and courts where war criminals have been convicted. Also, thanks to the European Union, Ukrainians are building their own criminal prosecution systems, which provide for the arrest and imprisonment of Russian war criminals in accordance with UN international standards,” he said.

Regardless of these concerns and the other problems Ukrainians are facing as the full-scale invasion goes into its fifth year, some are looking to the future with a degree of hope.

“I feel a mix of determination, resilience, anger, and hope of victory,” Tetiana, a nurse in the Dnipropetrovsk region, who asked not to be identified for security reasons, told IPS. “Glory to Ukraine!” she added.

*Name changed to protect identity.

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A Community Health Worker in a door-to-door campaign to vaccinate people in communities in Nanyamba village, Mtwara Region, in southeastern Tanzania. Credit: Kizito Makoye/IPS

By Kizito Makoye
DAR ES SALAAM, Tanzania, Oct 28 2025 (IPS)

When COVID-19 hit Tanzania in 2020, Alfred Kisena’s life was torn apart. The 51-year-old teacher still remembers the night he learned that his wife, Maria, had succumbed to the virus at a hospital in Dar es Salaam. He wasn’t allowed to see her in her final moments.

“The doctors said it was too dangerous, and the virus was contagious,” Kisena said, gazing at a faded photo of her hanging on the wall.

Maria’s burial took place in eerie isolation. Municipal workers dressed in white protective gear lowered her body into a tomb at Ununio Cemetery on the city’s outskirts.

“Saying goodbye to a loved one is sacred, but I didn’t get a chance,” he said.

Across Tanzania, many families endured the same pain—losing loved ones and being denied the rituals that give meaning to loss. The government imposed strict measures: banning gatherings, restricting hospital visits, and prohibiting traditional burial rites. Schools shut down, and for three months, Kisena’s five children stayed home, their education abruptly halted.

“I was not working, so it was hard to meet the needs of my family,” he said. “We survived on the little savings I had.”

Five years later, as the scars of that crisis linger, Tanzania is charting a new path toward resilience. Earlier this month, the government launched its first-ever Pandemic Fund Project, aimed at strengthening the country’s capacity to prevent and respond to health crises.

Supported by a USD25 million grant from the global Pandemic Fund and USD13.7 million in co-financing, the initiative marks a shift from reactive crisis management to proactive preparedness. It unites local and international partners—including WHO, UNICEF, and FAO—under a “One Health” framework that recognizes the interconnectedness of human, animal, and environmental health.

Learning from the Past

The memories of COVID-19 and the more recent Marburg outbreak remain vivid. When the pandemic first struck, Tanzania’s laboratories were under-equipped, surveillance systems were weak, and community health workers were overwhelmed.

Tanzania’s Deputy Prime Minister, Doto Biteko, said during the launch that the lessons from those crises shaped the country’s new determination.

“For the past 20 years, the world has battled multiple health emergencies, and Tanzania is no exception,” he said. “We have seen how pandemics disrupt lives and economies. Strengthening our capacity to prepare and respond is not optional—it is a necessity.”

That necessity has only grown as Tanzania faces rising risks of zoonotic diseases linked to deforestation, wildlife trade, and climate change. The new project aims to address these vulnerabilities by upgrading laboratories, expanding disease surveillance, and training health workers across the country.

The Human Frontlines

In southern Kisarawe District, 38-year-old community health worker Ana Msechu walks along dusty roads with a backpack containing medicine, gloves, and health records.

“Sometimes I walk for three hours just to reach one family,” Msechu said. “During the pandemic, people stopped trusting us. They thought we were bringing the disease.”

With no protective gear or transport allowance, Msechu faced villagers’ suspicion head-on. At the height of the pandemic, she lost a colleague to the virus. Yet she continued, delivering messages about hygiene and vaccination.

“Sometimes we didn’t even have masks—we used pieces of cloth instead,” she recalled.

The new initiative, she believes, could change that. Implementing partners plan to supply personal protective equipment (PPE), digital tools for data collection, and regular training sessions.

“If we get proper support and respect, we can save many lives before diseases spread,” she said.

“Community health workers are the backbone of resilience,” said Patricia Safi Lombo, UNICEF’s Deputy Representative to Tanzania. “They are the first point of contact for families and play a critical role in delivering life-saving information and services.”

UNICEF’s role will focus on risk communication and community engagement—ensuring that people in rural and urban areas understand preventive measures, recognize early symptoms, and trust the health system.

Between Fear and Duty

Hamisi Mjema, a health volunteer in Kilosa District, remembers how fear became his biggest enemy.

When the Marburg virus hit last year, his job was to trace suspected cases and educate families about isolation.

“I was insulted many times, and some families wouldn’t even let me into their homes,” he said.

Without transport or communication tools, Hamisi walked from one remote village to another with his bicycle, often relying on farmers to share their phone airtime so he could report cases to district health officials.

Under the new initiative, local health officers say community health workers will receive field kits, digital disease-reporting tools, and risk communication materials in local languages.

“It will make our work safer and faster,” he said. “When we detect something early, the whole country benefits.”

Fighting Misinformation

In a lakeside village in Kigoma, volunteer health educator Fatuma Mfaume recalls how rumors once spread faster than the virus itself.

“People were afraid,” she said. “They said vaccines would make women barren. Others believed doctors were poisoning us.”

Armed with a megaphone, Mfaume moved through villages trying to dispel falsehoods—often facing insults. But her persistence paid off. Slowly, women began bringing their children for immunization again.

With the new project, she hopes community workers like her will gain formal recognition and training in communication skills.

“Many of us work without pay,” Mfaume said. “If this project can train us properly and give us materials, we can fight not just disease but fear and lies too.”

Animal-Borne Threats

At the same time, the Food and Agriculture Organization (FAO) is strengthening animal health systems, recognizing that most pandemics originate from animals.

“By improving coordination between veterinary and public health services, Tanzania is taking vital steps to prevent zoonotic diseases before they spill over to humans,” said Stella Kiambi, FAO’s Emergency Centre for Transboundary Animal Diseases Team Lead.

These measures include upgrading veterinary laboratories, improving disease surveillance in livestock markets, and training field officers to detect early signs of outbreaks.

The World Health Organization (WHO) is also supporting efforts to strengthen human health systems—from expanding testing capacity to developing rapid response teams.

“This project marks a bold step forward in health security,” said Dr. Galbert Fedjo, WHO Health Systems Coordinator. “It advances a One Health approach that links human, animal, and environmental health.”

Rebuilding Trust and Hope

For Priya Basu, Executive Head of the Pandemic Fund, Tanzania’s project represents “an important step in strengthening the country’s preparedness to prevent and respond to future health threats.”

Across Africa, the Fund—established in 2022—has supported 47 projects in 75 countries with USD 885 million in grants, catalyzing more than USD 6 billion in additional financing.

According to the World Bank, every USD 1 invested in pandemic preparedness can save up to USD 20 in economic losses during an outbreak.

For Tanzania—a nation that lost thousands of lives and suffered deep economic shocks during COVID-19—the stakes couldn’t be higher.

“Preparedness is about saving lives and livelihoods,” said Dr. Ali Mzige, a public health expert. “It’s about making sure families don’t suffer when a pandemic strikes.”

For Kisena, the government’s new initiative is a quiet promise that the lessons of loss have not been forgotten.

“Maria’s death taught me how precious life is,” he said. “If this project can protect even one family from that kind of pain, then it will mean her death was not in vain.

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Adequate maternal care during pregnancy, childbirth and the postpartum period is essential to curbing the high maternal mortality rates in Latin America, which stopped falling due to women's health care problems during the COVID pandemic. CREDIT: Government of Tigre / Argentina

By Mario Osava
RIO DE JANEIRO, May 27 2022 (IPS)

Brazil had the dubious distinction of champion of maternal mortality in Latin America during the COVID-19 pandemic, with a 77 percent increase in such deaths between 2019 and 2021.

A total of 1,575 women died in childbirth or in the following six weeks in the year prior to the pandemic in Latin America’s largest and most populous country, with a population of 214 million. Two years later the total had climbed to 2,787, according to preliminary data from the Health Ministry’s Mortality Information System.

In Mexico, the second-most populated country in the region, with 129 million inhabitants, the increase was 49 percent, to 1,036 maternal deaths in 2021. And in Peru, a country of 33 million people, the total rose by 63 percent to 493 maternal deaths.

In Colombia, recent data are not available. But authorities acknowledge that in 2021 COVID-19 became the leading cause of maternal deaths, as it was in Mexico.

Brazil is the extreme example of multiple mistakes and of stubborn denialism that led to many avoidable deaths, particularly of pregnant women, according to experts and women’s rights activists on the occasion of the International Day of Action for Women’s Health, celebrated May 28.

In Latin America maternal mortality remains a major problem.

The Pan American Health Organization (PAHO), the regional office of the World Health Organization (WHO), states that “maternal mortality is unacceptably high” and that they are “mostly preventable” deaths, which especially affect pregnant women in rural areas.

These levels, the agency adds, will delay reaching target 3.1 of the 17 Sustainable Development Goals (SDGs): to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

A woman takes part in a care program for pregnant women in a low-income area of the northern state of Pará, Brazil. PAHO warned that the disruption of health services caused by COVID drove up maternal mortality rates in Latin America and the Caribbean. CREDIT: UNFPA

Something smells rotten

“Inadequate prenatal and obstetric care,” largely due to inadequate medical training in these areas, is the cause of the tragedy in Brazil, said physician and epidemiologist Daphne Rattner, a professor at the University of Brasilia and president of the Network for the Humanization of Childbirth.

“Hypertensive syndrome is the main cause of death in Brazil, while in the world it is hemorrhage. In other words, there is some failure in a simple diagnosis like hypertension and in managing it during pregnancy and childbirth,” she said in an interview with IPS from Brasilia.

Of the 38,919 maternal deaths between 1996 and 2018 in Brazil, 8,186 were due to hypertension and 5,160 to hemorrhage, according to a Health Ministry report. These are direct obstetric causes, which accounted for just over two-thirds of the deaths. The rest had indirect causes, pre-existing conditions that complicate childbirth, such as diabetes, cancer or heart disease.

An excess of cesarean sections is another factor in mortality. It is “an epidemic” of 1.6 million operations per year, the Health Ministry acknowledges. This is equivalent to about 56 percent of the total number of deliveries. The proportion reaches 85 percent in private hospitals and stands at 40 percent in public services, well above the 10 percent rate recommended by the WHO.

“They don’t practice obstetrics, they practice surgery, they don’t know how to provide clinical care, and the result is more maternal deaths,” Rattner lamented.

And the pandemic made the situation more tragic.

Black women protest to demand respect for their rights in Brazil. Black women are the greatest victims of maternal mortality caused by COVID-19 in the country. They account for almost twice the number of deaths of white mothers, according to a study by the Oswaldo Cruz Foundation, the leading national health research institution. CREDIT: Fernando Frazão / Agência Brasil

The stork doesn’t come anymore

Brazil missed the target of reducing maternal mortality by 75 percent by 2015, from 1990 levels, but it was moving in that direction. The maternal mortality ratio (MMR) per 100,000 live births in the country fell from 143 to 60, a 58 percent drop.

The Stork Network, a government strategy adopted in 2011 to improve assistance to pregnant women and the infrastructure of maternity hospitals, humanize childbirth, ensure family planning and better care for children, helped bring the MMR down.

But COVID-19 and the government’s response to it caused a setback of at least two decades in Brazil’s maternal mortality rate.

Coronavirus killed more than 2,000 pregnant and postpartum women in the last two years and there are at least 383 other deaths from severe acute respiratory syndrome that may have been caused by COVID-19, according to the Feminist Health Network, an activist movement that has been fighting for sexual and reproductive rights since 1991.

The way the government of far-right President Jair Bolsonaro acted “was a maternal genocide, not just a disaster,” said Vania Nequer Soares, a nurse with a PhD in public health who is a member of the Feminist Health Network.

The government’s denialism and its response to the pandemic aggravated mortality in general, which already exceeds 666,000 deaths, as well as maternal mortality. Health authorities took more than a year to recognize that pregnant women were a high-risk group for COVID-19, made it difficult for them to receive intensive care and delayed their vaccination, Soares said.

To make matters worse, they decided to dismantle the Stork Network, whose public policies had promising results, and adopted new rules of “obstetric violence” included in the brand new Maternal and Child Care Network (Rami), which concentrates all power in doctors and hospitals, to the detriment of other actors and dialogue, she told IPS by telephone from Lisbon.

Miriam Toaquiza, a teenage mother, and her newborn daughter, Jennifer, are photographed at a hospital in Ecuador. Latin America is second in the world in teen pregnancy, one of the causes of the high maternal mortality rates in the region. CREDIT: Gonzalo Ortiz/IPS

Undernotification and negligence

But the numbers of maternal deaths are probably higher. Brazil was slow to begin using COVID-19 diagnostic tests and did not test widely. And because clinical identification of the new disease was doubtful, many mothers probably died without the correct diagnosis, especially in the first year of the pandemic, Rattner argued.

A study published this month in the scientific journal The Lancet Regional Health – Americas, with accounts from the families of 25 pregnant women who died of COVID-19, revealed three practices that condemned many women to death on the verge of childbirth.

First, doctors refused to hospitalize or better examine those who complained, for example, of difficulty breathing. They attributed it to late pregnancy and delayed a diagnosis that could have saved at least one life.

In other cases, health centers turned away pregnant women because they were dedicated to the COVID-19 emergency, arguing that they could not accept pregnant women because of the risk of infecting them. And in maternity wards, pregnant women were turned away because of the risk that they could bring in coronavirus and affect other women.

Finally, pregnant women who managed to be accepted in hospitals were denied intensive care, under the argument of protecting the baby’s life. In other words, the choice was made to save the child, to the detriment of the mothers, without consulting the families.

This was confirmed by the fact that all 25 pregnant women died, but 19 babies survived. Four families told the health professionals that they wanted the mother to be saved, even arguing that she could have other children in the future, but this proved to be in vain.

The study by three researchers from the Anis Institute of Bioethics, Human Rights and Gender, based in Brasilia, corroborates the complaint of the Feminist Health Network that 20 percent of the pregnant and postpartum women did not have access to intensive care and 32.3 percent were not put on ventilators.

Women must be given protagonism, so that “they can take ownership of the process of motherhood, including childbirth,” said Ligia Cardieri, a sociologist who is executive coordinator of the Feminist Health Network.

Fewer mechanical interventions, a reduction of c-sections that increase risks, including anesthetics, and greater involvement of nurses and other maternal health actors are other recommendations to avoid so many maternal deaths, she told IPS from Curitiba, capital of the southern state of Paraná.

In other Latin American countries, pregnant women with COVID-19 suffered a similar lack of attention and problems.

Nearly a third of them were not given intensive care or respiratory support during the pandemic, revealed a study of 447 pregnant women from eight countries, including five from South America, two from Central America and one from the Caribbean, according to PAHO data.

The study, published in The Lancet Regional Health – Americas, is from PAHO’s Latin American Center for Perinatology/Women’s Health and Reproductive Health (CLAP/WR).

People wearing face masks at a Bus stop in Macau, China near a public hospital. This week’s 73rd World Health Assembly had member states adopt a resolution to review the global response to the coronavirus pandemic. Photo by Macau Photo Agency on Unsplash

By Samira Sadeque
UNITED NATIONS, May 20 2020 (IPS)

This week’s 73rd World Health Assembly had member states adopt a resolution to review the global response to the coronavirus pandemic. The World Health Organisation (WHO) will also undergo  an evaluation for its response to the outbreak.

At the virtual assembly, Chinese President Xi Jinping outlined China’s response to the COVID-19 pandemic, saying they did their “best to stem cross-border transmission” and to help other countries in need. He said in that China supported the idea of a “comprehensive review” of the world’s response to the pandemic, once it has been contained, in order to measure efficiencies of the responses.

“This work should be based on science and professionalism, led by WHO and conducted in an objective and impartial manner,” Xi said, adding that “solidarity and cooperation” are the strongest way to defeat the virus.

Xi also announced that China  would fund $2 billion over the next three years, with a focus on developing countries, to support their  efforts to combat COVID-19.

China’s response to COVID-19 has also come under heavy scrutiny, especially as reports continue to emerge that China may have a significantly higher number of COVID-19 cases than the country’s data shows.

President of the assembly, Keva Bain from the Bahamas, lauded the WHO and its director Dr. Tedros Adhanom Ghebreyesus, calling his leadership through this time “inspiring.”

“This era of COVID-19 ushers in new technology,” she added. “It requires new knowledge, new innovations, flexibility, [and] meaningful, respectful country interactions as well as new and greater global partnerships.”

Harsh criticism from U.S.

The assembly ended on the heels of United States President Donald Trump presenting his letter to Tedros, which defended cutting support  to the organisation in April.

In the letter posted on Twitter, Trump claimed the WHO did not maintain the same level of scrutiny for China as it did for the U.S. and that its failure to hold China accountable for its lack of transparency regarding data of its COVID-19 cases has “been extremely costly for the world”.

However, some experts believe that such harsh criticism of the WHO at this time could be problematic.

Dr. Jennifer Huang Bouey, a senior researcher at the Center for Asia and Pacific Policy, told IPS that the WHO has played a key role in containing a virus that is so global.

“I found it very unfortunate that this happened at this moment because WHO is in a primary position to do the coordination and the technical support for a disease that can cross borders,” she told IPS. “This is exactly the time that countries need to work together and help countries that have weaker systems.”

Bouey’s research has focused on how China’s public health response has been shaped since it first addressed the Severe Acute Respiratory Syndrome (SARS) crisis almost two decades ago. SARS is also a viral respiratory disease, caused by the SARS coronavirus or SARS-CoV.

“During SARS there was no data-collection system at all,” she said, “but after SARS the government put in a lot of funding to centralise the surveillance system.”

She attributed China’s failure to respond appropriately in part to the miscommunication between local and central government, belonging to a “very top-down system” where locals don’t want to be held accountable for an emerging disease.

Regardless, she said the disease is “ruthlessly revealing” some of the problems at both country level and international level, and that WHO should not be blamed for its initial response in January, because the scale of the pandemic was not fully realised at that point.

Way forward

Meanwhile, other experts have said what will make a difference is how these current reactions translate to proper action in the future.

“It is one thing to talk about diagnostic tests, medicines and vaccines being universally, timely and equitably available, but if countries and multilateral institutions providing funding to developers do not do so with the necessary strings attached, then these will remain words on paper and will not translate into medicines in health care providers’ and patients’ hands,” Katy Athersuch, a senior policy adviser at Médecins Sans Frontières (MSF) Access Campaign, told IPS.

She said that it’s crucial that data and technology being used to test and document the cases are “openly shared to ensure that production can take place on the scale that is needed in order to provide for people everywhere in the world, not just for those in the highest income countries.”

Bouey echoed a similar sentiment, and said there are lessons every country can take from the crisis.

“We’re always in the cycle of either neglect or panic, so whether COVID-19 can help us overcome that — to put into a plan, or regulation, [to see] whether these surveillance systems are still sensitive and whether we are still up to date on the strategies for a pandemic — these are lessons for every state and also for international organisations.”

Excerpt:

A trafficked survivor reunites with family in Vietnam. Courtesy: Blue Dragon Children’s Foundation

By Neena Bhandari
SYDNEY, Australia, May 18 2020 (IPS)

A single mother, Mai (name changed) had the responsibility of providing for her young son and grandparents, who had brought her up in a poor rural province in southern Vietnam’s Mekong Delta. While she was looking for employment, somebody approached her on social media with an offer of a high-paying job in China. When she arrived in China, she was sold into a forced marriage.

For two months, Mai suffered violence and beatings from her ‘husband’, who kept her locked in the house. When she tried to fight back, the ‘husband’ sold her to another man seeking a wife. She was forced to have sex as the family wanted a child. When she became pregnant, she was given some freedom and allowed to work in a nearby shoe factory. Desperate to escape this forced marriage and modern slavery, she managed to connect online with a Vietnamese man, who referred her to Blue Dragon Children’s Foundation, an Australian charity working in Vietnam.

• A forced marriage is when a person is married without freely and fully consenting because of either coercion, threat or deception.
• The Asia Pacific region predominates in the numbers of victims of modern slavery. The region had 55 percent of the victims of forced marriage worldwide.
• Sexual exploitation was also rife in the region with more than seven in 10 victims worldwide, according to the 2017 Global Estimates of Modern Slavery.

Mai is amongst a small number of fortunate women, who were able to seek help and be rescued. She returned to Vietnam in December 2018, and after the police were able to arrest her trafficker, she was reunited with her family.

“I have been able to rebuild my life with Blue Dragon’s support. Recently, I have completed hospitality training and have a part-time job in a city café. I can save some money to send to my grandparents, who are nurturing my children,” Mai told IPS through a social worker. 

Her experience resonates with many young Vietnamese women, who are tricked and trafficked into sexual slavery. Blue Dragon Children’s Foundation rescues 110 to 130 women each year. Its co-CEO Skye Maconachie told IPS, “Once rescued and returned to Vietnam, their family situation usually hasn’t changed and they are still impoverished and vulnerable to being re-trafficked or exploited. Our teams provide emotional, psychological, basic living and legal support as they work with each survivor to help them learn skills and get employment.”

While survivors seek normalcy on first returning home, Maconachie said, “It is not until later in their recovery that the trauma they have experienced emerges and impacts them with flashbacks, Post-Traumatic Stress Disorder, low self-esteem, fear and distrust.”

The Asia and Pacific region predominates in the numbers of victims of modern slavery. The region had 55 percent of the victims of forced marriage worldwide. Credit Zofeen Ebrahim/IPS

• Women and girls are disproportionately affected by modern slavery, accounting almost 29 million or 71 percent of the overall total.
• On any given day in 2016, an estimated 15 million people were living in a forced marriage.
• More than one third of all victims of forced marriage were children at the time of the marriage, and almost all child victims were girls, according to joint research by the International Labour Organization, and the Walk Free Foundation, in partnership with the International Organisation for Migration.

Walk Free’s Senior Research Analyst, Elise Gordon told IPS, “Our research has indicated that traditional views of the role of women, girls and children could be contributing to increased vulnerability to forced and underage marriage, forced sexual exploitation, and commercial sexual exploitation of children in the Asia Pacific region.”

Trafficking contravenes fundamental human rights and freedoms. As Australian Red Cross’ National Coordinator for Trafficked People Program, Sally Chapman told IPS, “We are concerned that people who have been trafficked may be subject to various forms of physical, sexual and emotional violence. They are often afraid of arrest, detention and deportation; don’t trust authorities, and can also be discriminated against throughout any referral and support processes. The impact can be significant and include permanent control and/or monitoring of their movement, fear of physical retaliation, death, or reprisal against or harm to their loved ones.”

The Australian Red Cross last year provided assistance with essential items, such as food, toiletries and clothes while addressing accommodation, health and wellbeing needs to individuals identifying as being from 48 different countries.

Chapman cautioned, “During disasters and crises, people can be displaced from their homes, separated from their family members, school and employment can be interrupted, and systems of social support and law and order can break down. These factors can exacerbate the risk of trafficking, particularly for women and girls. The humanitarian impact of climate change and extreme weather events is likely to increase trafficking and forms of exploitation and slavery.”

The Australian Red Cross works to raise awareness in communities so that the general public, service providers and authorities can reduce risks; recognise the signs of exploitation, trafficking, slavery; be able to respond safely; and refer someone for help and support.  

• The hidden nature of exploitation makes it difficult to ascertain the extent of victimisation in Australia, which is primarily a destination country for people trafficked from Asia, particularly Thailand, Korea, the Philippines, Malaysia and Pacific Island countries.
• Recent research by the Australian Institute of Criminology (2019) estimated that only one in four victims are detected. This means that human trafficking and modern slavery victims in Australia ranged between 1,300 and 1,900 in 2015–2017.
• Modern Slavery trends vary widely across the Asia Pacific region and men, women and children are exploited for various reasons – slavery, human trafficking, slavery-like practices such as servitude, forced labour, debt bondage, forced marriage or organ harvesting.

As Jenny Stanger, Executive Manager of the Catholic Archdiocese of Sydney’s Anti-Slavery Taskforce told IPS, “Awareness about trafficking and slavery outside the sex industry has grown only in the last decade. Human trafficking for organ removal poses new challenges. There is a global shortage of organs and there are a lot of vulnerable people who might be willing to sell their organs. There is also mounting evidence that prisoners in China are forcibly having their organs harvested for profit”.

Global Financial Integrity (GFI) estimates that 10 percent of all organ transplants including lungs, heart and liver, are done via trafficked organs. The most prominent organ traded illicitly is the kidney. The World Health Organisation estimated that 10,000 kidneys are traded on the black market worldwide annually, or more than one every hour.

Stanger, who has worked as a case manager and advocate for survivors of trafficking and slavery for over two decades, relates the story of a Filipino woman, who was approached by an Australian couple visiting the Philippines. They were looking for a kidney donor and they offered the woman money and permanent residency in Australia if she were to donate a kidney to their dying family member. The woman was advised by her own community that this was a good opportunity for her, so she agreed.

After arriving in Australia, she was treated poorly and forced to clean and cook for the dying recipient and her husband. By chance the woman disclosed the complete nature of the arrangement to a health worker in the hospital where the transplant was to take place and that person contacted Stanger for assistance. The kidney transplant did not take place and the recipient eventually died.

“In the end, the government response to human trafficking recognised the Filipino woman as a human trafficking victim. She was able to stay in Australia after she chose to cooperate with the Australian Federal Police in an investigation that was unable to be prosecuted. This failure changed Australian law forever because, at the time, the Commonwealth Criminal Code did have an offence to adequately address organ trafficking.  A new ‘organ trafficking’ offence was enacted in 2013,” Stanger explained.

• It is estimated that the illegal organ trade conservatively generates approximately $840 million to $1.7 billion annually, according to GFI, a Washington DC-based think tank, that provides analyses of illicit financial flows.
• In 2015, Australia legislated to make clear that that slavery offences have universal jurisdiction; it amended the Criminal Code to increase the penalties for forced marriage from four years to seven years’ imprisonment for a base offence, and from seven to nine years’ imprisonment for an aggravated offence.
• The ASEAN-Australia Counter-Trafficking Initiative, launched in August 2019 to fight human trafficking, modern slavery and forced labour, is a 10-year programme that will work to strengthen criminal justice responses and protect victim rights in the region.
• The Global Sustainability Network ( GSN ), which actively supports the United Nation’s Sustainable Development Goal 8 of decent work and economic growth, has focused much of its work on eliminating modern slavery.

“COVID 19 has demonstrated that when the whole world decides to take action to address a critical issue, change is possible. I hope that one day our leaders will truly recognise the tragedy of modern slavery and find the political will to make freedom from modern slavery a reality for everyone, ” Stanger added.

This is part of a series of features from across the globe on human trafficking. IPS coverage is supported by the Airways Aviation Group.

The Global Sustainability Network ( GSN ) is pursuing the United Nations Sustainable Development Goal number 8 with a special emphasis on Goal 8.7 which ‘takes immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking and secure the prohibition and elimination of the worst forms of child labour, including recruitment and use of child soldiers, and by 2025 end child labour in all its forms’.

The origins of the GSN come from the endeavours of the Joint Declaration of Religious Leaders signed on 2 December 2014. Religious leaders of various faiths, gathered to work together “to defend the dignity and freedom of the human being against the extreme forms of the globalisation of indifference, such us exploitation, forced labour, prostitution, human trafficking” and so forth.

Excerpt:

Congestion in public hospitals is frequent in Latin America even without epidemics. Long waits and the need to resort to out-of-pocket spending to obtain medical assistance are common in the region. CREDIT: Courtesy of Integralatampost

By Humberto Márquez
CARACAS, Apr 4 2020 (IPS)

Health systems in Latin America, already falling short in their capacity to serve the population, especially the poor, are in a weak position and face serious risks when it comes to addressing the COVID-19 pandemic.

Low levels of health spending and a relative scarcity of hospital beds are indicators that most countries in the region do not guarantee universal access to healthcare and risk being overwhelmed by the wave of the new coronavirus.

“Even in well-organised and robust health systems the challenges posed by a pandemic are felt swiftly, and this is even more true in weak ones like those in much of Latin America. In epidemiology, if you trail behind an epidemic, you are going to suffer havoc,” former Venezuelan health minister José Félix Oletta (1997-1999) told IPS.

Of the 630 million people in Latin America and the Caribbean, 30 percent do not have regular access to health services, mainly due to geographic or income issues, according to the Pan American Health Organisation (PAHO), an affiliate of the World Health Organisation (WHO).

That figure is in line with the proportion of people living in poverty, according to the Economic Commission for Latin America and the Caribbean (ECLAC), which counts 185 million poor people in the region, and reports that over 10 percent of the total regional population – 68 million people – live in extreme poverty.

The regional average for health spending is under four percent of gross domestic product (GDP) and only 2.2 percent is central government expenditure, according to ECLAC and PAHO figures.

In 2014, the region’s governments committed to raising health spending to at least six percent of GDP, but only Cuba (10.6 percent), Costa Rica (6.8 percent) and Uruguay (6.1 percent) have met that goal.

The most industrialised countries spend eight percent of GDP on health, between 3,000 and 4,000 dollars per inhabitant per year, compared to about 1,000 dollars per person in Latin America. Argentina, Chile, Cuba and Uruguay spend around 2,000 dollars per person, but Haiti, Honduras and Venezuela spend less than 400.

Out-of-pocket spending (the amount people spend directly on a service) is low in Cuba, Costa Rica or Uruguay (10 to 20 percent) and very high in others such as Venezuela (63 percent), Guatemala (54 percent) or the Dominican Republic (45 percent).

These out-of-pocket payments by individuals illustrate the inadequacy of public health provision, as well as of social security or private insurance, and the fact that the poor are the most vulnerable because they sometimes refrain from seeking care that they cannot afford.

Another indicator is the number of beds available in hospitals, which does not measure the quality of infrastructure, staffing or efficiency in these facilities: the regional average is 27 per 10,000 inhabitants. A portion, sometimes very small, are intensive care beds.

But “it is not enough to have hospitals and health centres. They must properly combine human resources, infrastructure and equipment, medicines and other health technologies, to provide quality care,” said PAHO Director Carissa Etienne.

If the COVID-19 pandemic continues to spread in the region, Bolivia, Guatemala, Haiti, Honduras, Nicaragua, Paraguay and Venezuela are “the Latin American countries most at risk,” according to PAHO.

A view of the University Hospital of Maracaibo, the “oil capital” of Venezuela, in the west of the country. Large hospitals do not guarantee good-quality service in and of themselves, because skilled staff and adequate equipment and technology are also needed, says PAHO. CREDIT: SAHUM

IPS took a closer look at the situation in four countries to show the different weaknesses and strengths of health systems in the region.

Brazil, persistent inequality

Over the last three decades, the largest country in the region, with a population of 211 million, has developed a unique public health system, with programmes such as Mais Médicos, Farmácia Brasil Poupa Lar and Estratégia Saúde da Família. The latter is a strategy enabling a team of doctors, nurses and assistants to care for up to 3,000 people at a local level.

Mais Médicos deployed up to 18,000 doctors, more than half of them Cuban, in remote villages and isolated rural communities in Brazil. But since December 2018 the programme shrank after Brasilia severed relations with Havana and thousands of Cuban doctors were forced to return home.

The social gap is widening, since public health, with 44 percent of the hospital beds, must serve 75 percent of the population, while private clinics have more than half of the beds for 25 percent of the inhabitants.

In 2009, Brazil had 18.7 beds per 10,000 inhabitants, which dropped to 17.2 in 2017, half of them in four of its 27 states, in the wealthier southeast. It has 47,000 intensive care beds, but for every one in the public health system – 90 percent of which are occupied – there are 4.6 in the private health sector.

Brazil “is not prepared to face the coronavirus epidemic, not so much because of a lack of resources, but due to their poor distribution, the high level of inequality in terms of access to services, poor management and lack of equity,” epidemiologist Eduardo Costa, an international cooperation advisor at the National School of Public Health, told IPS.

Cuba, medicine for export

The Cuban health system, touted by the socialist government as one of the achievements of the revolution, is public and free of charge for the country’s population of 11.2 million, with 90 doctors for every 10,000 inhabitants, according to official figures.

Although there are no precise figures on how many of its 47,000 beds are for intensive care – and there are complaints from the public about delays for non-urgent surgical procedures – Health Minister José Ángel Portal said the island nation has 274 beds to treat seriously ill coronavirus patients and plans to add another 200.

One of Cuba’s flagship programmes is the international medical cooperation missions, which began in 1963 and have sent 407,000 doctors, technicians and assistants to 164 countries, providing free medical assistance to poor countries, under the format of cost-sharing to other nations, or as a source of income in some cases.

The annual income from this programme – 29,000 doctors worked in 65 countries in 2019 – exceeds six billion dollars. For the COVID-19 pandemic, Cuba is setting up 14 medical brigades with 600 members, more than half of whom are women.

Chile is prepared, although it’s never enough

In Chile, a country of 18.7 million people, health coverage is public for 14 million and private for three million, and there is a separate system for the 400,000 members of the armed forces, put in place by the dictatorship of General Augusto Pinochet (1973-1990), which has not been modified.

All workers are required to contribute seven percent of their wages to the health institution of their choice. Those who are covered by the public health system complain about long waits of weeks or months to see a doctor and of up to a year or even more for surgery.

These were some of the shortcomings that fueled the mass protests that broke out in Chile in October 2019 and raged for months until a referendum was agreed to allow voters to choose whether to replace the constitution inherited from the dictatorship.

Chile has 22 hospital beds for every 10,000 inhabitants. That is a total of about 32,000, with 3,300 for emergencies, which the government aims to increase to 5,200 in the face of the pandemic.

Nelly Alvarado, a professor at the Diego Portales University and a public health specialist, told IPS that “the health system’s capacity is never going to be enough in the face of an unexpected situation coming from the rest of the world.”

She pointed out that critical care beds “have never been abundant either in Chile or the rest of the world. They are expensive and highly complex, because sophisticated equipment and specialised staff are required.”

Venezuela, on the verge of collapse

Official health statistics became unavailable in Venezuela over the past decade. But studies by non-governmental organisations warn that the health care system is on the verge of collapse and that the country is experiencing a “complex humanitarian emergency.”

Venezuela, a country of 30 million people, is at the bottom of the regional charts in terms of health spending and the provision of hospital beds. The NGO Doctors for Health reported that during 2019 there were power failures in 63 percent of 40 large hospitals it monitors, and water supply failures in 78 percent.

Barrio Adentro, a programme launched in 2003 that brought thousands of Cuban doctors to low-income areas, has almost disappeared and most of its premises have closed.

“We are at the bottom of a PAHO list of 33 countries in the hemisphere in terms of preparing for COVID-19,” Oletta said. “And the pandemic follows setbacks in vaccination campaigns and containment of preventable diseases that have re-emerged, such as malaria, measles and tuberculosis.”

The health crisis is part of the general collapse of basic services that has accompanied the economic recession over the past five years and hyperinflation over the past three years, driving the exodus of almost five million of Venezuela’s 32 million inhabitants. Among those who have emigrated were more than 22,000 doctors, according to the medical association.

Latin America, lagging behind in health care and spending, should heed the call of Maria Neira, WHO Director for the Department of Public Health, Environmental and Social Determinants of Health: “Something we have all forgotten is that investment in public health and health systems should not be regretted…it is always going to be a profitable investment.”

This article includes reporting by Ivet González in Havana, Mario Osava in Rio de Janeiro, and Orlando Milesi in Santiago.

A United Nations report states that the fact that women make up 70 percent of the global health workforce puts them at greater risk of infection. This is a dated photo of Catherine a nurse at Jinja referral hospital,in Uganda. Credit: Lyndal Rowlands/IPS.

By Samira Sadeque
UNITED NATIONS, Apr 3 2020 (IPS)

As the number of coronavirus cases continues to grow, concerns are simultaneously growing about the current and long-term effects this will have on certain demographics — specifically, women, the youth, migrant workers, and many employees around the world. 

This week, the United Nations launched a report “Shared Responsibility, Global Solidarity: Responding to the socio-economic impacts of COVID-19” that detailed how these communities are affected disproportionately by the current pandemic and quarantine. 

A burden on women

At the centre of it remains one demographic that likely bear the strongest brunt of it: women. 

“The fact that women make up 70 percent of the global health workforce puts them at greater risk of infection,” read part of the report. “The current crisis threatens to push back the limited gains made on gender equality and exacerbate the feminisation of poverty, vulnerability to violence, and women’s equal participation in the labour force.”

But just because women make up almost three-quarters of global healthcare professionals, does not mean they’re given the proper respect. According to a March 2019 report by the World Health Organisation, despite having such a crucial role in the public health industry, women continue to face various kinds of abuse or negligence in society, including but not limited to being attributed to a “lower status” or engaging in paid and often, unpaid roles, and being subject to gender bias and harassment. 

Meanwhile, given such a large percentage of the workers are women, the requirement of child-care can hinder a woman’s ability to work during the pandemic. According to the Centre for American Progress, currently millions of healthcare workers have a child under the age of 14, who might be struggling to manage between going to work and taking care of their children. 

“Because mothers’ employment is especially likely to suffer when they cannot find reliable child care, this finding suggests that millions of vital health workers currently could be struggling to secure child care, endangering their ability to work at a moment when the U.S. health care infrastructure is already spread too thin,” the report reads. 

At the launch of the report, U.N. secretary general António Guterres called for policies to not only address the pandemic and contain its spread, but also that would adopt measures to address the long-lasting impact of the crisis. He called for “designing fiscal and monetary policies able to support the direct provision of resources to support workers and households, the provision of health and unemployment insurance, scaled up social protection, and support to businesses to prevent bankruptcies and massive job losses.”

Plight of migrant workers, lack of connectivity further problems

Another demographic that is deeply affected as a result of the pandemic are migrant workers, according to the report.

“Migrants account for almost 30 percent of workers in some of the most affected sectors in OECD countries,” read the report. “Massive job losses among migrant workers will have knock on effects on economies heavily dependent on remittances, such as El Salvador, Haiti, Honduras, Nepal, Tonga, Tajikistan and Kyrgyzstan.” 

The International Organisation for Migration (IOM) in Nepal cites the government’s figure that estimates between 700 000 to 800 000 Nepali migrants workers in India. 

“With the outbreak of COVID-19 and measures by the GOV to mitigate the risks, country is in a national lock – down. Economic production has stopped and many seasonal Nepali migrant workers had to stop working,” Lorena Lando, Chief of Mission at IOM Nepal, told IPS.

“Thousands returned back to Nepal before the lock down, others are still in India but unable to work. Many of the migrant workers are daily wages earners, and now they no longer have an income to support their families. Even for those that return back home, job opportunities will be scarce, keeping in mind that was the first reason why they travelled abroad for work.”

“The economic impact of COVID-19 in countries such as Nepal will be much bigger than other countries, and while some actions to take are good for the short term, other will need be a socio economic recovery response in longer vision,” she added. 

Beyond migrant workers, International Labour Organisation (ILO) estimates that the current crisis in the labor market could see between five and 25 million job losses. 

“The current crisis exacerbates the feminisation of poverty, vulnerability to violence, and women’s equal participation in the labour force,” the report noted, highlighting that even amid joblessness, women will be affected disproportionately. 

Furthermore, connectivity to the internet, especially at a time when all work and courses are moving online, is also of priority. The report states that currently an estimated 3.6 billion of the world’s population remain without connectivity, which means they may not have access to education, health information and telemedicine. 

As advocates had told IPS last week, digital access and internet connectivity is key at this time in order to ensure communication among communities.