Category: Health

With the release of the latest food security report from the Integrated Phase Classification (IPC) on war-ravaged Gaza since December, World Food Programme (WFP) chief economist Arif Husain walked UN News through the process.

What is the threshold for famine?

Famine is essentially a technical term, referring to a population that faces widespread malnutrition and hunger-related deaths due to a lack of access to food. 

“We say there is a famine when three conditions come together in a specific geographic area, whether a town, village, city, even a country,” WFP’s Mr. Husain explained.

• At least 20 per cent of the population in that particular area are facing extreme levels of hunger;
• 30 per cent of the children in the same place are wasted, or too thin for their height; and
• The death – or mortality – rate has doubled, from the average, surpassing two deaths per 10,000 daily for adults and four deaths per 10,000 daily for children.

“You can clearly see that in a way, famine is admission of collective failure,” he said. “We should act way before the famine, so people don’t starve, children are not wasted and people don’t die of hunger-related causes.”

UN Photo/John Isaac

A mother and her child rest at a relief centre in Bati, Ethiopia, in 1984. (file)

How is hunger tracked?

Famines today are different than those experienced in the 1970s or 1980s, when drought was the main driver in Ethiopia and other nations, Mr. Husain told UN News, adding that years ago, when a famine occurred, “we could say, ‘I’m sorry. I did not know. If I had known, I would have done something about it.’”

“Today, we see crises in real time, so we cannot say we did not know,” he explained. “The onus is much higher today than it has ever been before.”

Climate-related food insecurity is now closely monitored thanks to a detailed tracking system used by international humanitarian agencies wherever they work, and today, famines or risks of one developing are now largely driven by conflict, as seen in South Sudan, Yemen and now in the Occupied Palestinian Territory.

In the 21st century, climate-related famines have largely been averted thanks to an innovative tool to track acute hunger, developed during the crisis in Somalia in 2004 by the UN Food and Agriculture Organization (FAO) and now used by humanitarian agencies worldwide.

This initiative is called the Integrated Security Phase Classification, or IPC.

© WFP/Saleh Hayyan

A family shares a meal in Yemen with food provided by the UN World food Programme (WFP).

What is the IPC?

The IPC is an innovative multipartner initiative for improving food security and nutrition analysis and decision making.

The IPC classification and analytical approach facilitates governments, UN Agencies, non-governmental organizations, civil society and other relevant actors in working together to determine the severity and magnitude of acute and chronic food insecurity and acute malnutrition situations in a country according to internationally recognised standards.

The initiative spread has been used in more than 30 countries, and a global partnership of 19 organisations is leading the development and implementation of the IPC at global, regional and country levels.

With over 20 years of application, the IPC has proved to be one of the best practices in the global food security field.

It is also a model of collaboration in over 30 countries in Latin America, Africa and Asia.

The IPC tracks hunger but can also raise alarms ahead of potential widespread acute malnutrition before it transforms into more serious life-threatening conditions.

How does the IPC work?

The IPC itself does not collect data. The information comes from its humanitarian partners operating on the ground.

The information can cover food security, nutrition, mortality and people’s livelihoods as well as calorie intake, what kind of coping strategies people use to find food and the measurements of children’s arms to monitor malnutrition, known as the middle-upper arm circumference, or MUAC.

“Data collection does not stop, even in war zones,” Mr. Husain said.

In cases where locations are unreachable, mobile phone surveys are deployed to get information, and if that is not possible, satellites can generate information.

© WFP/Claire Nevill

The UN continues to provide lifesaving food assistance in the Tigray region of Ethiopia.

Technical experts from IPC partners crunch a large volume of data to better inform decision makers who can effectively address needs on the ground, with a view to avoiding a worst-case scenario.

IPC experts then gather to analyse the data, classifying populations into five categories: phase one is minimal or no stress in finding food reported; phase two sees people facing stress; phase three is a food crisis; phase four is an emergency; and phase five is considered to be a catastrophe or famine.

Based on the share of the population in each of the five phases, geographical areas are given a severity phase as well, presented by different colours on the IPC map, from the least severe to the most severe phase (minimal, stress, crisis, emergency and famine). 

Each of these geographic area phase classifications has important and distinct implications for where and how best to intervene, and therefore influences priority response objectives.

© UNICEF/Eyad El Baba

Displaced children search for food near the tents where they are staying with their families in Rafah in southern Gaza.

Famine Review Committee

In the case of a suspected famine, there is an additional step, which calls upon the IPC Famine Review Committee.

Comprising globally recognized experts in their fields, from nutrition and health to food security, the committee convenes when more than 20 per cent of the affected people are in IPC phase five, meaning famine or catastrophe conditions.

The consensus-based process requires all partners to agree on a conclusion that the Famine Review Committee verifies.

The committee meets and examines all the data and analyses provided by IPC partners to determine whether the findings are credible and to see whether the data justifies a famine classification or a plausible famine classification.

The experts then outline what is happening now and offer projections for the next three- or six-month periods, like in the IPC report on Gaza in December.

UNDP Somalia

Somalia’s drought has left more than two million people facing severe food and water shortages.

How aid agencies respond to hunger alerts

Humanitarian agencies use these invaluable IPC classifications to plan and to help people from the phase three crisis level onwards, with the specific goal of avoiding a famine.

“What we try to do is to get to the people, so we never have to deal with the famine like situation, or IPC phase five,” Mr. Husain said. “We work very, very hard at the crisis level and definitely at the emergency level to save people’s lives so that they don’t get to IPC phase five, which is classified as a famine.”

That includes ramping up food aid.

“When we do that, we can save lives,” he said.

© UNICEF/Herold Joseph

Children are taken by their mothers for nutrition screening in the Delams neighbourhood of Port-au-Prince, Haiti.

‘For us, famine is the “F” word’

While needs remain high, according to WFP estimates, 309 million people in 72 countries face a level of hunger that is at the crisis level or worse. 

“For us, famine is the ‘F’ word,” Mr. Husain said, emphasizing that the end goal is prevention.

“If we are going to avoid these famines, the easiest way would be to stop the conflicts,” Mr. Husain said, “but if that is going to take time, then it is our responsibility that we are able to feed the innocent people, are able to provide the water and necessities like medicine to those people who are stuck in those places or may be displaced from those places.”

New IPC report on Gaza: Famine is ‘imminent’

The new IPC Famine Review Committee released it latest report on 18 March on the worsening situation in Gaza, where UN teams on the ground have long warned of an imminent famine against a backdrop of the ongoing Israeli military offensive in Gaza sparked by Hamas’s 7 October attacks against Israel.

© UNICEF/Eyad El Baba

Mohammad is getting measured as part of a malnutrition screening at a UNICEF-supported pediatrician clinic tent in Rafah in southern Gaza.

Read our news story on the launch here.

Israel’s ground invasion has killed over 31,000 Gazans and, along with restrictions on aid entering the bombarded and besieged enclave, has triggered widespread hunger and growing numbers of deaths from starvation.

Since February 2024, Gaza’s entire population – 2.2 million people – had been classified at the IPC phase three crisis level or worse, the “highest share of people facing high levels of acute food insecurity that the IPC initiative has ever classified for any given area or country”, the group said.

The initial clarion call came from UN agencies and partners soon after the Israel’s October invasion following which the IPC Famine Review Committee produced its first report on Gaza at the end of 2023.

With keys drivers of food insecurity persisting, a second one was produced in March 2024. 

Here are some highlights from the latest report:

• “The conditions necessary to prevent famine have not been met and the latest evidence confirms that famine is imminent in the northern governorates and projected to occur anytime between mid-March and May 2024”
• 88 per cent of Gazans now face food insecurity levels classified as IPC level four or above, which corresponds to an emergency level or worse
• Among this population, about 50 per cent (1.1 million people) are in a catastrophe situation, or IPC phase five
• The level of acute malnutrition is expected to surpass the famine threshold (30 per cent) in northern Gaza, with the steep increase of wasting prevalence, from 0.8 to 15 per cent, over several months
• The upward trend in non-trauma mortality is also expected to accelerate, resulting in crossing the famine threshold imminently by May 2024 
• The increased nutritional vulnerability of children, pregnant and breastfeeding women and the elderly is a particular source of concern

Relatively modest new investment could result in significant health and economic benefits, with up to $39 worth of benefits for each dollar invested, the UN agency said, announcing the findings of a study conducted in Brazil, Georgia, Kenya and South Africa.

The returns extend beyond monetary, encompassing substantial improvements in public health outcomes and the mitigation of TB’s devastating impact on individuals, families and communities.

“The investment case outlines the health and economic rationale for investing in evidence-based, WHO-recommended interventions on TB screening and prevention that can contribute to advancing universal health coverage,” WHO Director-General Tedros Adhanom Ghebreyesus said.

“Today, we have the knowledge, tools and political commitment that can end this millennia-old disease that remains one of the world’s top infectious killers.”

Crucial advocacy tool

While significant strides have been made to combat the disease, with an estimated 75 million lives saved since 2000, TB continues to cause about 1.3 million deaths annually and affects millions more worldwide.

Moreover, multidrug-resistant TB (MDR-TB) is a growing public health concern, with only about two in five people having accessed treatment in 2022.

Progress in the development of new TB diagnostics, drugs and vaccines remains constrained by the overall level of investment in these areas, WHO said, adding that it is clear much more needs to be done to combat TB.

Against this background, its investment case is expected to serve as a vital advocacy tool for securing increased resources for TB screening and preventive treatment, aligning with the commitments made by governments at the 2023 High-Level Meeting on TB.

2024 World TB Day

As the global community prepares to World TB Day on 24 March under the theme Yes! We can end TB!, the message reiterates the importance of high-level leadership, increased investments and accelerated uptake of important recommendations, WHO said.

“The next five years will be critical for ensuring that the political momentum we have now is translated into concrete actions towards reaching global TB targets,” said Tereza Kasaeva, Director of WHO’s Global Tuberculosis Programme.

“WHO will continue to provide global leadership for the TB response, working with all stakeholders until we reach and save every person, family and community impacted by this deadly disease”.

Figures released by the UN Interagency Group for Child Mortality Estimation (UN IGME) reveal the global under-five mortality rate has declined by 51 per cent since 2000.

Some countries such as Cambodia, Malawi, Mongolia and Rwanda reduced under-five mortality rate by over 75 per cent over the time period.

UNICEF Executive Director Catherine Russell praised the dedicated efforts of midwives, health workers and community health workers, whose commitment has contributed to the remarkable decline.

“Through decades of commitment by individuals, communities and nations to reach children with low-cost, quality and effective health services, we’ve shown that we have the knowledge and tools to save lives,” she said.

The UN IGME was formed in 2004 to share data and enhance methods for child mortality estimates, tracking progress made towards child survival goals. It is led by UNICEF and comprises the World Health Organization (WHO), the World Bank Group and the Population Division at the UN Department for Economic and Social Affairs (DESA).

Long road ahead

Despite these gains, the report noted there is still a long way to go to end all preventable child and teen deaths, as millions continue to die from treatable causes, including preterm birth complications, pneumonia, diarrhoea and malaria.

The majority of these deaths occur in sub-Saharan Africa and southern Asia, highlighting regional disparities in access to quality healthcare.

The report also noted that economic instability, conflicts, climate change and the lingering impact of the COVID-19 pandemic are continuing to undermine progress and exacerbate existing disparities in mortality rates.

“While there has been welcome progress, every year millions of families still suffer the devastating heartbreak of losing a child, often in the very first days after birth,” said Tedros Adhanom Ghebreyesus, WHO Director-General.

“Where a child is born should not dictate whether they live or die. It is critical to improve access to quality health services for every woman and child, including during emergencies and in remote areas.”

Critical frontline responders

Improving access to quality health services and saving children’s lives from preventable deaths requires investment in education, jobs and decent working conditions for health workers to deliver primary health care, including community health workers.

Juan Pablo Uribe, Global Director for Health, Nutrition and Population at the World Bank, emphasized the need to accelerate progress.

“We owe it to all children to ensure they have access to the same healthcare and opportunities, regardless of where they are born.”

That’s one billion people who lived with the disease in 2022, a number that has doubled among adults and quadrupled among five to 19-year-olds since 1990, according to data from the study, published in The Lancet, a renowned United Kingdom-based medical journal.

“This new study highlights the importance of preventing and managing obesity from early life to adulthood through diet, physical activity and adequate care, as needed,” said Tedros Adhanom Ghebreyesus, Director-General of WHO, which contributed to the study.

Global targets to curb obesity

A complex chronic disease, obesity has become a crisis, unfolding in epidemic proportions that reflect a stark rise over the past few decades.

While the causes are well understood, as are the evidence-based interventions needed to contain the crisis, the problem is that they are not implemented, according to the UN health agency.

“Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” the UN health chief said.

It also requires the cooperation of the private sector, which must be accountable for the health impacts of their products, he added.

The study’s data also showed that 43 per cent of adults were overweight in 2022.

Deadly consequences

In the Europe, overweight and obesity are among the leading causes of death and disability, with estimates suggesting they cause more than 1.2 million deaths annually, according to WHO’s regional office.

Obesity increases the risk for many noncommunicable diseases, including cardiovascular diseases, type 2 diabetes and chronic respiratory diseases. Overweight people and those living with obesity have been disproportionately affected by the consequences of the COVID-19 pandemic, often experiencing more severe disease and other complications, the UN health agency said.

It is considered a cause of at least 13 different types of cancer, likely to be directly responsible for at least 200,000 new cancer cases annually across Europe, according to WHO.

United Nations

SDG 3

SDG 3: HEALTHIER GLOBAL POPULATION

 

• Promote mental health and wellbeing and strengthen the prevention and treatment of substance abuse
• Reduce the number of deaths and illnesses from pollution, contamination and tobacco
• Achieve universal health coverage and provide access to affordable, essential vaccines and medicines
• Reduce global maternal mortality rate to less than 70 per 100,000 live births and under-five mortality to at least 25 per 1,000 live births
• End epidemics of AIDS, tuberculosis and malaria and combat hepatitis and other communicable diseases

 

Sustainable development hinges on ensuring healthy lives and promoting wellbeing at all ages

Undernutrition challenges

Malnutrition, in all its forms, includes obesity, inadequate vitamins or minerals and being overweight. It also includes undernutrition, which covers wasting, stunting and being underweight (or thinness) and is responsible for half of the deaths of children under five.

The study showed that even though the rates of undernutrition have dropped, it is still a public health challenge in many places, particularly in Southeast Asia and sub-Saharan Africa.

Countries with the highest combined rates of underweight, or thinness, and obesity in 2022 were island nations in the Pacific and the Caribbean and those in the Middle East and North Africa.

WHO’s acceleration plan

At the World Health Assembly in 2022, Member States adopted the WHO acceleration plan to stop obesity, which supports country-level action through 2030.

To date, 31 governments are now leading the way to curb the obesity epidemic by implementing the plan.

Some of the ways they are doing that include such core interventions as breastfeeding promotion and regulations on the harmful marketing of food and beverages to children.

Healthy diets for all

© Unsplash/Anna Pelzer

A healthy diet can prevent obesity.

One of the co-authors of the study, Dr. Francesco Branca, Director of WHO’s Nutrition and Food Safety Department, said there are “significant challenges” in implementing policies that aim to ensure affordable access to healthy diets for all and create environments conducive to physical activity and overall healthy lifestyles.

“Countries should also ensure that health systems integrate the prevention and management of obesity into the basic package of services,” he said.

Addressing undernutrition requires action in the agriculture, social protection and health sectors to reduce food insecurity, improve access to clean water and sanitation and ensure universal access to essential nutrition interventions, according to the UN health agency.

The new study used data from 200 countries and territories, including 3,663 population-based studies with 222 million participants. WHO contributed to the data collection and analysis of the study and disseminated the full dataset through its Global Health Observatory.

“Life is very difficult here,” hospital manager Dr. Haidar Al-Qudra told UN News.

Currently, only 12 of Gaza’s 36 hospitals are “partially functioning”, according to the World Health Organization (WHO), with the rest destroyed by Israel’s near constant bombardment of the enclave.

As the war in Gaza enters its fifth month, Israeli forces continue to raid healthcare facilities, with Al Amal Hospital among the latest to endure a weeks-long deadly siege. Israel claims Hamas is operating in hospitals, but Palestinian authorities and medical professionals have refuted those allegations.

Al Amal Hospital took 40 direct hits that killed at least 25 people and incapacitated the health facility, according to a report from the UN Humanitarian Country Team in Palestine.

Buildings continue to be peppered by Israeli sniper fire, communications blackouts and the detention of health workers alongside drastic shortages of essential goods and restrictions on what lifesaving supplies can enter the complex, according to UN agencies and news reports.

‘We are surrounded now’

Since the start of the siege on Al Amal in January, more than 8,000 displaced people have been evacuated from the complex, many having used the premises as shelter from Israeli attacks in the area.

Nearby fighting and multiple bombings found health workers “were afraid for their lives” and, for more than a month, they have been unable to leave the hospital buildings, Dr. Al-Qudra said.

“We are surrounded now, and patients cannot reach the hospital because they are not allowed to walk in the streets near the hospital,” he said. “Our ambulances now cannot move outside the hospital.”

UN News

Dr. Haidar Al-Qudra, manager of Al Amal Hospital.

‘Most patients have either died or are suffering’

Many surgical cases had been postponed, he warned, noting that five months had passed without many operations being performed, from mastectomies and thyroidectomies.

“All of these normal operations were not performed in any hospital, therefore, most of these patients either died or they are suffering more and more,” Dr. Al-Qudra said.

Extensive damage has also forced management to try to transfer patients to get the care they need. After the ceiling on the third floor collapsed, he said they would now refer around 35 patients to other nearby hospitals.

But, the remaining hospitals across Gaza are badly overcrowded. In Rafah, 77 newborns were sharing 20 incubators, according to UNFPA.

© UNFPA Palestine/Bisan Ouda

At Rafah’s Al-Helal Al-Emirati Maternity Hospital, 77 babies share 20 incubators. 

‘First time we see the sun’

Dr. Waheed Qudih, a surgical consultant at Al Amal Hospital, was among the medical staff trapped inside during the siege.

“This is the first time we see the sun,” he said, referring to the arrival of a joint UN mission to the battered premises this week. “We have not been allowed to leave the hospital door since 21 January.”

He, like others, he stayed inside on site “to help injured patients”.

“We perform a lot of surgeries for injured patients, such as general surgery and orthopaedics,” he explained. “We have saved the lives of many patients, and we did what we could with limited facilities.”

UN News

Dr. Waheed Qudih, a consultant surgeon at Al Amal Hospital.

Joint UN relief mission

Following reports of the besieged medical centre, the UN deployed a joint mission, with WHO alongside agencies for humanitarian affairs office OCHA, the mine action service (UNMAS), reproductive health agency UNFPA, the safety and security department (UNDSS) and UNRWA, the Palestine refugee relief agency.

Meeting with health workers in the besieged hospital and checking on the condition of the patients and companions inside, the mission’s goal was to evacuate 24 patients and deliver lifesaving food, water and fuel as well as emergency surgical supplies and antibiotics to treat an estimated 50 infections.

The mission had to leave 31 non-critical patients behind, an OCHA spokesperson said on Tuesday, highlighting that the Israeli military had not given “any information or any communication” about why the mission ambulances were detained for at least seven hours nor why the paramedics “had been taken out, forced to undress”.

‘There are still patients here’

Dr. Athanasios Gargavannis, a trauma surgeon and WHO emergency staff member, said the level of devastation he witnessed is “beyond imaginable”.

“However, there are still patients here,” he said. “Our top priority is to identify and refer a number of them so they can continue to receive care.”

As chronic delays at Israel’s Kerem Shalom crossing continues, with news reports showing Israeli protesters blocking the entry of aid into Gaza, some nations have resorted to emergency aid airdrops this week.

But, that represents only a tiny portion of what is needed at Al Amal and other Gaza health centres.

© WHO/Christopher Black

WHO and the Palestinian Red Crescent Society lead lifesaving missions to transfer critical patients from besieged hospitals in Gaza.

‘No respect for any humanitarian law’

At Al Amal Hospital, Dr. Al-Qudra said that before the war, it had 100 beds, focused on maternal and child health and was able to meet basic surgical and internal medicine needs while providing specialized rehabilitation services.

The destruction caused by the bombing of the third floor reduced the capacity to an estimated 60 beds. Supplies are scarce. Communications blackouts continue.

On Wednesday, the Palestinian Red Crescent Society said Israeli forces continued to detain seven team members for nearly three weeks, including a doctor, anesthesia technician and ambulance staff, who were taken into custody during Israel’s raid on Al Amal Hospital, according to media reports.

These days in Gaza, Dr. Al-Qudra stressed, there is “no respect for any rule or any humanitarian law related to the medical staff”.

© WHO/Christopher Black

UN staff help to transfer patients out of Nasser Hospital in Gaza.