Physicians under bombardment: In solidarity with frontline health heroes and heroines  

By: Dr. Duha Shellah, Medical & Health Sciences Division, Palestine Academy for Science & Technology

As a physician, Palestinian and voice of physicians in Palestine and the eastern Mediterranean region (EMR). I am sending out this call for solidarity, to raise the voices of the health workforce in Gaza. The Health Workforce is under an unimaginable workload because of the dire situation wrought by the war in the Gaza Strip. The war has entered its fourth week of continuous horrific attacks which led to extensive destruction of all forms of life in Gaza, civil and health infrastructure were widely destroyed which is alarming for a collapse of the health system in Gaza. The number of casualties received in hospitals is huge. Some of my colleagues have not gotten any rest been home or even seen their families since the beginning of the war. Moreover, some were surprised to see their family members among the casualties and martyrs.  With the tragic loss of 73 health personnel who have been killed, 11 were killed on duty, and more than 100 have been injured, and 26 ambulances are out of service, the health system is taking its last breath, and the result will be havoc. 

Contacting friend physicians,  nurses, midwives, and social workers is different now. It takes days for them to respond. where in two or three minutes of rest, they text us “We are fine”. Most International humanitarian agencies announced the difficulty in contacting their staff on the ground in Gaza. With no electricity or fuel stocks, the situation is devastating. The lack of beds in wards and emergency rooms with a shortage of medical supplies is indeed overwhelming, to the system and staff.  No form of health services is available except life-saving services.

With the collapse of 25 hospitals and most of the primary healthcare facilities in Gaza, the health situation is catastrophic. The vulnerable groups are with no access to essential health services. The shutdown of backup generators in hospitals would place the lives of thousands of patients at risk.  civilians in Gaza are at risk of infectious diseases due to lack of personal hygiene and clean water, besides, overcrowding in shelters. Many children have stopped regular immunization, and their right to grow in a safe and clean environment and to develop physically and mentally has been retracted from them. 

The 16-year blockade on Gaza has fragilized the health system, with physician and specialty shortages and a lack of medical equipment and medications. Those years of socioeconomic decline political instability and conflict have weakened the public health infrastructure, leaving the strip with limited access to clean water, sanitation, and hygiene. The ongoing war on Gaza has amplified what the Palestinians and the health system have been facing. The deprivation of clean water, food, fuel, and electricity is causing a humanitarian catastrophe. Keep in mind the environmental hazards of the continuous heavy bombardment and extensive destruction of the sewage system. 

I call for solidarity with physicians, public health specialists, health workers, and humanitarian workers, all those working on the frontlines trying to save lives, and most importantly save the Palestinian identity in the Gaza Strip. International Humanitarian law must be abided, indiscriminate violence and collective punishment should end and an immediate ceasefire is a must. All lives matter, all lives.  Physicians and health workers have to stand for each other in times of war and conflict, it is a moral duty to stand out for those on the frontlines of danger, who are working under bombardment, and who have been oppressed for years. 

Urgent Appeal for Humanitarian Action in Gaza – Join the Call for Peace

The most lethal attack ever registered against a hospital happened on Oct 17, 2023 in the Gaza Strip (or Gaza), with hundreds of people dead and injured. The World Health Organization issued a strong protest.

This week, The Lancet featured an open letter written by Luis Eugenio Portela Fernandes de Souza, President of the World Federation of Public Health Associations. The letter is addressed to influential leaders, including the Presidents of the United Nations Security Council, United Nations General Assembly, the United Nations Secretary-General, high-ranking political and health authorities of Israel and Palestine, and His Excellency Pope Francis.

Call for Fellows: WFPHA Fellowship Program 2024

The World Federation of Public Health Associations (WFPHA) is pleased to announce the WFPHA Fellowship Program 2024, hosted by the Norwegian Public Health Association (NOPHA). This fellowship program aims to strengthen less developed public health associations and foster global partnerships by facilitating the exchange of expertise and knowledge among public health professionals from various countries. This unique opportunity is designed for talented, highly motivated mid-level professionals dedicated to a career in public health and seeking opportunities that can significantly contribute to their personal and professional growth. For 2024, two candidates will be selected to participate.

Objectives:

1. Connecting emerging public health associations with an established and proven public health association to promote public health growth and understanding.
2. Facilitating and improving communication and strengthening networks among the professionals of public health associations around the world.
3. Developing partnerships and practices that will positively affect and improve public health.
4. Documenting success or challenges that could serve as a learning tool for all public health associations.
5. Aligning equity in public health globally.
6. Presenting and publishing findings and outcomes at the end of the project.

Duration:

The fellowship program will run from October 10 to November 10, 2024, and will take place in Norway, mainly in Oslo. During the fellowship period, the accommodation will be organized by the Norwegian Public Health Association. It could be private homes, student accommodations, or tourist accommodations.

Eligibility:

The call for applications is open to all members of public health associations affiliated with the WFPHA who are in good standing. Applicants should hold a long-term mid-level position within their public health associations and play a central role in the public health associations secretariat. Proficiency in English is mandatory. Gender and geographic balance will be considered in the selection process.

Funding:

Travel, accommodation, visas, and main meals for selected fellows will be covered by WFPHA. The fellows’ public health associations are required to cover travel/health insurance costs and anything not specified. There are no per-diem allowances. Fellows are responsible for getting a visa if requested, as well as any authorization needed, which must be obtained no later than two months before the start of the fellowship. NOPHA can assist with an invitation letter.

Evaluation:

All parties involved will participate in the evaluation of the program. Fellows are expected to provide a report at the General Assembly after completing fellowship and provide an update on the impact of the program, i.e., the development and progress of fellows’ public health associations, 18 months after its conclusion.

Application Process:

Applicants should send their C.V., a motivation letter highlighting what they would like to learn during the scholarship period, and a letter of support from the national public health associations, signed by its president or general secretary. Applications should be sent to Maria.Mata@wfpha.org by December 15, 2023. Shortlisted candidates will be contacted for an interview in January 2024.

Next Steps:

The selected fellows will be contacted in spring 2024. They will start their fellowship preparation through a series of online meetings with WFPHA and NOPHA from April 2024 on. They will take part in the development of the fellowship program and attend the NOPHA conference during their stay. During the fellowship program, the fellows shall actively participate in proposed activities, including, but not limited to, webinars, meetings with key organizations, stakeholders, the NOPHA board, etc. Join us in shaping the future of global public health. Let’s work together to promote equity, foster collaboration, and make a difference in public health communities worldwide.

For further inquiries, please contact Maria Mata.

WFPHA Condemns Attacks on Civilian Populations Everywhere

Following the strong condemnation of the terrorist attacks on civilians in Israel perpetrated by Hamas, the World Federation of Public Health Associations (WFPHA) also strongly condemns the Israeli forces’ attacks on civilians in the Gaza Strip.

As alerted by the United Nations Secretary-General (UN-SG), António Guterres, while Israel’s security concerns are legitimate, military operations must be carried out strictly with international humanitarian law, and “civilians must be respected and protected at all times, and civilian infrastructure must never be a target”. Similarly, the European Union Foreign Policy Chief (EUFP-Chief), Josep Borrell, said clearly: “A collective punishment against all Palestinians will be unfair and unproductive. It will be (…) against the interest of peace. Not all the Palestinian people are terrorists.”

As a global public health organization, the WFPHA stresses that besides deaths and immediate threats to life, war and recurrent violence profoundly impact the mental health of people living in regions of armed conflict. Moreover, in conflict-affected areas, access to health services is limited due to the destruction of infrastructure and lack of resources.

Civilians in the Gaza Strip must have access to humanitarian aid, food, clean water, and healthcare services. The immediate release of hostages and the safe removal of children, women, and older people must be carried out urgently.

The WFPHA joins the UN-SG and the EUFP-Chief’s calls for respect for the lives of civilians in the Gaza Strip, remembering that Palestinians and non-Palestinians, including UN staff have been victims in this war.

Adaptive Climate Migration as a Public Health Imperative

By Hannah Marcus, WFPHA Environmental Health Working Group

In an era of accelerating global climate change, human mobility has reached unprecedented levels. While it is acknowledged that many cases of human migration in the context of climate change are forced or involuntary, particularly where adaptation measures have failed to achieve sufficient resiliency of communities against impending slow- and sudden-onset disasters, there are also many cases where migration is, itself, a voluntary adaptive measure to secure otherwise unattainable physical safety and life-sustaining resources. It is in these cases that migration can be viewed as adaptation.

Indeed, the framing of “migration as adaptation” is now widely used in academic literature on climate migration. This perspective has ignited more widespread recognition that adaptive human movement can have far-reaching social, economic, and health benefits for migrants and their communities of origin. A quick look at the history of human movement in response to environmental change further reaffirms this.

However, in the absence of a favorable policy environment, such benefits may not be accrued or maximized, and migrants may find themselves in conditions of even greater precarity. The potential health consequences of such policy failures are extreme. Vulnerability to sexual and other forms of abuse along poorly safeguarded migration routes may spur severe mental distress and psychological trauma in affected persons. Simultaneously, prolonged settlement in poorly serviced refugee and internally displaced persons (IDP) camps can severely increase infectious and waterborne disease risk for camp residents. Without access to adequate healthcare services and social supports, urban migrants may also suffer from a myriad of communicable and non-communicable diseases. Meanwhile, “trapped populations”, lacking the option to relocate, will continue to face life-threatening food and water insecurity as their environment undergoes further degradation.

In contrast, supportive policies which enable individuals to move safely and securely from more to less climate-vulnerable regions can reap benefits for global public health protection and disease prevention. As the international public health community has long committed to the achievement of these goals under the Global Charter for the Public’s Health, it can be argued that there is a public health imperative for action on climate migration. The WFPHA has put forth several arguments in favor of this stance in a 2023 article published in the Journal of Migration and Health.

Most importantly, forcing individuals to remain in environmentally fragile settings, by not providing a viable option to relocate, can directly restrict adherence to healthy practices. For instance, if seawater intrusion has resulted in salinization of your only available water supplies, you are forced to suffer from hypertension and other health consequences to simply survive. Likewise, if there is insufficient available food because flooding or drought have destroyed the month’s harvest, mothers cannot uphold best practices for infant and young child feeding and nutrition, no matter how strongly recommendations are enforced by community health providers.

Not only can migration provide a path for improved health of otherwise disease-vulnerable populations residing in environmentally fragile settings, but it can also contribute to relieving pressure on already strained and under-resourced healthcare systems in such settings. As many of the regions of the world most vulnerable to drought, heat waves, flooding, and extreme weather events are in low- and middle-income countries, the burden of caring for injured and sick individuals in the face of natural disasters is frequently borne by the very healthcare systems least equipped to deal with such issues. Facilitating adaptive human movement in response to climate-driven health threats would enable a redistribution of this burden, and achieve a situation whereby disaster-effected individuals can access healthcare services more commensurate with their needs.

From a disease prevention standpoint, enhancing legal pathways for migration would drastically reduce population density in refugee/IDP camps, illegal settlements, and urban slums, all of which, due to poor living conditions and overcrowding, serve as active hubs for disease transmission. Simultaneously, providing migrants with adequate shelter, nutrition, water, sanitation, and hygiene, and humanitarian aid along transit paths would substantially reduce their vulnerability to contracting infections, waterborne illnesses, and sexually transmitted diseases due to gender-based violence on route.

Finally, stronger international coordination of migration through well-managed, legal asylum-seeking channels would enhance national capacities for regulating the disease screening of individuals crossing borders. Studies have shown that where legal migration alternatives are inadequate or nonexistent, individuals on the move will nonetheless pursue illegal routes to entry at destination sites. It has been shown that this makes epidemiological and demographic tracking on the national level substantially more challenging, as people’s whereabouts go unknown and any changes to national population makeup remain undocumented. Considering this, we can envision how the opening of safe and legal transit avenues, coupled with well-coordinated screening and registration processes, would substantially lessen this challenge, and enable far more timely, robust, and accurate epidemiological projections on which to base national public health policy planning. While the contention that migrants are likely disease carriers has been widely disputed by researchers anyway, secondary screening of border crossers through well-regulated, legal migration procedures would also enhance early detection of other illnesses, enabling appropriate early referrals for necessary health services.

Given the potential for adaptive climate migration to contribute towards the achievement of key global public health objectives, the international public health community MUST endorse measures which facilitate it under the right circumstances. Of course, interdisciplinary collaboration in helping communities to adapt to the impacts of climate change and remain in their, often preferred, location of origin remains a key public health responsibility. Yet, when environmental conditions, in combination with irremediable social, political, and economic vulnerabilities, impede the possibility of achieving a life of dignity, health, and safety, the option to relocate must be enabled, supported, and facilitated, as not just a legal/moral imperative, but indeed, as a public health one as well.

Climate Change Litigation: Guide for Public Health Professionals

By Giovanna Mazzola, WFPHA Environmental Health Working Group

The past several years have seen a significant increase of litigation over actions or inaction related to climate change. The total number of climate change court cases has more than doubled since 2017 and is growing worldwide. While most cases have been brought in the United States (US), Europe, the United Kingdom (UK), and Australia, about 17% of cases are now being reported also in developing countries, including Small Island Developing States. Climate change litigation is thus becoming an integral part of securing climate action and justice, as an effective tool to affect “the outcome and ambition of climate governance”. By using litigation to oblige governments and private sector polluters to address the climate emergency, claimants have been pushing for more ambitious regulations, opposing regulatory steps or new plans and proposed developments, or even requesting compensation measures for human harm. Moreover, climate litigation creates opportunities for public scrutiny and debate, raising awareness around governments’ inaction or harm caused by private sector polluters.

The success of climate litigation mainly relies on compiling a sufficient level of scientific evidence of current and likely future health impacts on populations. Strong cooperation between the legal and scientific communities is thus essential to the successful outcome of climate change litigation when harm to human health is at issue. Yet, public health experts are often unaware of the opportunities offered by litigation and of their crucial role in collecting, securing, and presenting evidence of harm to human health.

To address this gap, the European Public Health Association (EUPHA), the Faculty of Public Health (UK), the Groningen Centre for Health Law, the Aletta Jacobs School of Public Health (Netherlands), and other partners have developed a Guide on climate change litigation for public health professionals. The Guide will be released at the 16th European Public Health Conference in Dublin in November 2023.

With the assistance of the Environmental Health Working Group of the WFPHA, the Guide’s content draws on suggestions made by WFPHA member organizations and public health experts, who were surveyed to ascertain their interest in the proposed Guide and to advise on its content and use. Over 70 completed surveys were received. The survey assessed the level of engagement and interest shared by respondents in climate change issues and their current level of cooperation with local legal expertise. Overall, the results demonstrated that there is a keen interest in the public health community to better understand the importance of climate change litigation in addressing climate-related injustice and the opportunities offered by interdisciplinary collaboration. Yet, while most respondents (79,2%) reported they are already working on issues related to climate change, many of them (57%) declared not to have ready access to legal expertise, either internal or external, for guidance on policy matters.

The Guide will be available from the Faculty of Public Health website, which also contains other useful related resources for public health professionals.