The Human Consciousness Now...Our World in the Midst of Becoming...to What? Observe, contemplate Now.
SUVA, Fiji & SRINAGAR, India, Oct 5 2026 (IPS) - Extreme heat is increasingly threatening pregnant women and newborn babies around the world, with almost all maternal health professionals surveyed across five continents saying they have cared for women or infants whose health was affected by high temperatures.
The findings, released as climate ministers gathered in the Pacific ahead of the COP31 climate summit, provide an extremely distressing picture of how global heating is affecting maternity wards, delivery rooms and newborn-care units.
A survey of 1,001 healthcare professionals in Australia, Brazil, India, the United Kingdom and Zimbabwe found that 98 percent had personally cared for a pregnant woman whose health they believed was adversely affected by extreme heat.
Some 99 percent said they had cared for a foetus or newborn whose health, in their professional judgment, had been affected by extreme heat.
Almost three-quarters, 73%, said heat-related cases or complications affecting pregnant women had increased over the previous five years. The proportion rose to 76% when health workers were asked about complications involving foetal health, childbirth or newborn babies.
The survey was commissioned by the global health foundation Wellcome and conducted among obstetricians, gynaecologists, doctors, midwives, nurses and other maternal-health professionals between September 17 and October 1.
The findings were released in Fiji at the launch of Birthright, a global campaign seeking greater protection for pregnant women, babies and healthcare workers as temperatures rise.
Speaking at the event, United Nations Climate Change Executive Secretary Simon Stiell said climate change was creating a new and potentially deadly risk around pregnancy and childbirth.
“The picture is clear and very disturbing: as extreme heat worsens, pregnancy and birth are now a new faultline in the global climate crisis, and one which is potentially fatal,” Stiell said.
“This faultline must not become another deep chasm of climate-driven suffering, inequality and injustice.”
The survey offers detailed evidence of what healthcare professionals say they are already witnessing.
Among pregnant women,
25% reported seeing muscle cramps or muscle aches that they believed extreme heat had contributed to or worsened 24% reported severe fatigue, sleep problems or a reduced ability among pregnant women to carry out daily activities 23% reported breathing difficulties or worsening respiratory symptoms 23 percent reported pregnancy complications requiring additional monitoring or treatment, while an equal proportion reported hypertensive disorders, including pre-eclampsia More than one in five reported mental distress, anxiety or stress linked to heat 21% said they had encountered severe maternal illness requiring medical attention or hospital care 20% reported dizziness, fainting or loss of consciousness, while 19 percent reported preterm contractions, labour or birth Nearly 18% said they had observed pregnancy loss or stillbirth in circumstances where, in their professional judgment, extreme heat had contributed to or worsened the problem.The survey did not attempt to establish that heat alone caused individual complications. The responses provide information about the professional judgment and clinical experience of the healthcare workers questioned.
Protect Life at Its Most Fragile
The findings involving babies were similarly worrying.
36% of health professionals reported dehydration or heat-related illness among newborns during the pregnancy-related care they provided 34% reported low birth weight or restricted foetal growth 33% had observed breathing, feeding or temperature-regulation difficulties 28% said babies required additional monitoring, treatment or neonatal care, and a similar proportion reported preterm birth During the newborn period, 38% of respondents reported low birth weight or restricted growth 36% reported dehydration or heat-related illness, and another 36% reported breathing, feeding or problems regulating body temperature Almost 30% said heat-related conditions resulted in babies needing additional monitoring, treatment or neonatal care 9% percent reported stillbirth or neonatal death during the newborn period in cases where they believed extreme heat had contributed to or worsened the condition.Stiell said the findings showed that rising temperatures could no longer be treated simply as an environmental issue.
“The climate policy process is measured in degrees, targets and finance,” he said. “But a deep test of climate action is far simpler: whether we protect life at its most fragile.”
He said the world was entering conditions for which many health systems had not been designed.
“We are in a new, hotter world, as the world continues to burn planet-heating fossil fuels, overwhelmingly in G20 economies,” Stiell said.
“The last eleven years smashed records.”
He said rising temperatures meant “rising danger in pregnancy”, citing evidence linking extreme heat to premature birth, stillbirth, low birth weight and maternal complications.
A healthcare worker cradles a newborn baby at a maternal health facility, illustrating frontline efforts to protect mothers and infants amid mounting concerns over the impact of extreme heat on pregnancy, childbirth and newborn health. Credit: Wellcome
No One Is Immune
The survey also revealed significant differences between countries.
Zimbabwean health workers were among those reporting the sharpest increases.
Eighty-five percent of respondents in Zimbabwe said heat-related cases or complications affecting pregnant women had increased during the previous five years. The figure was 79% in Australia, 74% in Brazil, 66% in the United Kingdom and 62% in India.
When respondents were asked about foetal or newborn health, 89% of Zimbabwean health professionals reported an increase in heat-related cases or complications. The corresponding figure was 79% in Brazil, 78% in Australia, 68% in the United Kingdom and 66% in India.
The results suggest that the effects are being felt across countries with very different climates, incomes and healthcare systems.
Concern was also widespread.
More than 92% of all respondents said they were concerned about the impact of extreme heat on the health and well-being of pregnant women in the areas where they worked and 90% expressed concern about foetal health during pregnancy and childbirth, as well as the health of babies during the newborn period.
Zimbabwe recorded some of the highest levels of concern, with 97% of respondents concerned about foetal and newborn health.
Stiell said no country or family could consider itself completely insulated from the risk.
“No one is immune,” he said. “But the risks and impacts are not shared equally.”
The survey showed that extreme heat was also disrupting the healthcare systems expected to protect women and infants.
29% of health workers said they had seen increased urgent or emergency presentations during extreme heat 28% reported difficulties safely storing or using medicines, supplies or medical equipment 27% said pregnant women and their families found it harder to travel to or access healthcare 25% reported increased demand for advice, monitoring or treatment, while another quarter reported staff illness, fatigue or a reduced ability to work safely 24% had experienced interruptions to electricity, water, cooling systems, medical equipment or other essential services A similar proportion reported healthcare services becoming overburdened or having insufficient capacity Nearly one-quarter said temperatures inside healthcare facilities had become unsafe or uncomfortable.The findings highlight a basic problem in responding to extreme heat. Advising pregnant women to stay cool may be of little practical value when families lack air conditioning, cannot afford electricity, work outside, or live far from medical services.
“‘Staying cool’ is simply not an option when there is no cool place to go,” Stiell said.
“A safe birth is already too often shaped by geography, income and access to care. Without action, extreme heat will widen that injustice.”
The survey asked health professionals what most limited pregnant women’s ability to protect themselves and their babies.
26% cited limited awareness or understanding that extreme heat could affect health during pregnancy 24% cited the need to work outdoors or in hot conditions About 23% pointed to limited support from family or the wider community The same proportion cited limited access to cooling or air conditioning 23% identified the cost of electricity, water or other protective measures.Other barriers included existing health conditions, inadequate access to safe drinking water, homes that were difficult to keep cool, lack of employer support and difficulties travelling to healthcare facilities.
Only 0.4 percent said no factors limited women’s ability to protect themselves from extreme heat.
Stiell said such conditions meant that climate change risk was increasingly intertwined with inequality.
“Someone working outdoors, living in unregulated housing, travelling far to a clinic, or relying on facilities without water, power or cooling, cannot be protected by advice alone,” he said.
Harm that is not counted is too easily ignored
For Pacific Island countries, the issue is particularly sensitive.
Many small island states have contributed only a tiny fraction of historic greenhouse gas emissions but face rising sea levels, intensifying storms, heat and pressure on food, water and health systems.
“Here in the Pacific, climate change is no abstraction,” Stiell said.
“It is felt in homes, villages, farms, fisheries and clinics, in journeys for care, and in the availability and cost of food, water, power and transport.”
The Fiji event was held as ministers and climate officials gathered for the pre-COP meeting hosted by Australia and Fiji from October 5 to 8.
The meeting is intended to advance negotiations ahead of COP31 in Antalya, Türkiye, and give greater prominence to Pacific Island perspectives and climate solutions. Tuvalu was hosting a leaders’ event as part of the Pacific meetings.
Despite the growing risks, the survey suggests many healthcare workers believe they need more support to respond effectively.
An overwhelming 92% said they wanted additional training and resources to help pregnant women during periods of extreme heat. 55% said clearer national or international guidance on protecting pregnant women from extreme heat would help them perform their jobs better When asked what would most improve their ability to protect women and babies, 33% selected practical information and materials for pregnant women and families 31% called for improvements to buildings, cooling, ventilation, water or electricity 29% wanted stronger referral pathways and better coordination between health services A similar proportion called for improved data and surveillance on heat, pregnancy and newborn health, as well as better local heat alerts and communication 28% said more staff, time or funding during periods of extreme heat would help 28% called for greater community outreach to people who may otherwise be difficult for health services to reach.Stiell urged governments to make maternal and newborn health an explicit part of national climate adaptation and heat-response strategies.
“What is not named in a plan is too often not funded, not measured and not protected,” he said.
He outlined three priorities.
The first was to make pregnancy and newborn care part of national adaptation, health and extreme-heat planning.
That would require resilient clinics, dependable electricity and water supplies and properly trained health workers.
The second was to convert scientific evidence into direct protection, including improved guidance, professional training, heat alerts, safer medical facilities and health systems prepared before extreme weather strikes.
The third was better monitoring.
“Harm that is not counted is too easily ignored,” Stiell said.
“As temperatures rise, data must show where risks are growing, which interventions work, which communities are exposed, and where finance and technology support is needed.”
The survey found broad support among health workers for stronger policy action.
81% agreed that without further action, extreme heat would increasingly endanger maternal, foetal and newborn health during the next five years 82% said protecting pregnant women and babies from extreme heat should become a higher priority for health-system leaders and policymakers Another 82% agreed that better evidence on heat, pregnancy and newborn health would help drive effective action.Stiell linked the issue to broader international climate finance negotiations.
He said commitments on adaptation finance agreed at COP30 in Brazil needed to be implemented and called for governments and the international financial system to help mobilise $1.3 trillion annually for developing nations.
“For small islands and other nations that did practically nothing to cause this climate crisis, it underscores the need for support at scale,” he said.
He also pointed to the Belém Gender Action Plan and Belém Adaptation Indicators as mechanisms that could help governments measure climate-related health risks and build more resilient health services.
Stiell praised Türkiye’s COP31 presidency and Australia, which is serving as President of Negotiations, for putting health on the agenda ahead of the Antalya summit.
For Stiell, the issue ultimately goes beyond climate-negotiating language.
“I am a parent, but I cannot pretend to know what it feels like to carry a pregnancy through those conditions,” he said.
“Mothers, midwives, doctors, nurses and families speak from lived experience. We should listen.”
The survey suggests those voices are already delivering a clear warning.
Pregnant women are struggling with heat exposure. Babies are requiring additional care. Health workers are seeing more complications. Facilities are facing pressure on electricity, water, medicines and staff. And many doctors, nurses and midwives say they lack the training and resources they need.
“Pregnancy should be a time of hope,” Stiell said. “But for millions, it is becoming a time of anxiety, as climate impacts fill everyday life with risk.”
He ended with an appeal for governments to treat protection of mothers and babies as a basic test of climate policy.
“A changing climate must never be accepted as a reason pregnancy and birth become less safe,” he said.
“A newborn’s healthy start must never depend on a family’s ability to escape the heat.”
“This work is urgent, deeply human, and we all share the responsibility to drive it forward together.”
IPS UN Bureau Report
KIGALI, Oct 2 2026 (IPS) - Post-harvest losses, particularly in rural areas, threaten the gains Africa is making in agricultural production and export capacity.
In Sub-Saharan Africa, up to 40% of farm produce is lost because of a lack of cold storage, according to industry players.
Highly perishable farm produce, like fruits and vegetables, can go as high as 70%.
With agriculture accounting for one-third of the Gross Domestic Product and employing over 60%, such a loss threatens jobs and the livelihoods of millions of people.
Farmers in Africa grapple with a lack of reliable refrigeration, an underdeveloped cold chain and unreliable power storage, leaving harvests to heat and spoilage.
Poor road networks and limited refrigerated transport options also worsen the situation. Farmers transport fruits long distances to processing centres under non-ideal conditions, resulting in losses.
Renewable Energy Offers an Opportunity
At the Africa Food Systems Forum in Kigali, Rwanda, experts are exploring how renewable energy can ease the burden on farmers who often turn to diesel generators to cool their farms’ fresh produce.
Olamide Niyi-Afuye, Chief Executive Officer at Africa Minigrid Developers Association (AMDA), an industry association working to improve the operating environment for mini-grids, said the biggest gap is not awareness but aggregation and intentional market design.
“We already see individual examples of mini-grids powering agro-processing, cold storage and other productive activities,” he said.
“The challenge is that these are still too often treated as individual projects rather than part of a scalable commercial model.”
Mugwe Manga, a Climate Finance Lead at Financial Sector Deepening Kenya (FSD Kenya), an independent trust supporting micro and small enterprises, said energy presents a tremendous opportunity for smallholder farmers to capture more value from what they produce.
“Solar, increasingly combined with battery energy storage, is particularly important because it is modular, increasingly affordable and can be deployed relatively quickly in rural areas,” he said.
“Solar-powered irrigation, cold storage, drying, milling, cooling and agro-processing can reduce post-harvest losses, increase productivity, improve product quality and allow farmers to sell into higher-value markets.”
Manga said energy can become an important enabler of both climate resilience and higher farmer incomes.
“The productive use of energy for cold storage, solar-pumped irrigation, and agro-processing is critical to value capture, climate resilience, and adaptation that will strengthen smallholder farmers,” he said.
Nigeria, one of Africa’s largest economies, lost between $2.3bn and $3.3bn to post-harvest inefficiencies in 2025, according to industry players.
The food wasted due to poor storage and transport networks amounted to up to 40 million metric tonnes.
South Africa loses an estimated 10.3 million tonnes of food annually, about 19% of its fresh produce, according to a 2021 report titled Waste Research Development and Innovation Roadmap Research.
Funding Cooperatives Is a Better Funding Model
Renewable energy offers reliable and accessible solutions to cold storage and processing problems in Africa, but funding remains a major challenge.
Though prices of solar panels and batteries shipped from China have been declining in recent years, current prices remain high for many farmers, particularly smallholders in rural areas.
With low capital amid limited access to grants and loans, many cannot afford solar-powered agro-processing and cold storage facilities.
Experts said that clean energy is the cheapest technology to deploy when farmers work together.
“Due to the capital expenditure of some of these, it is important for farmers to organise themselves and come together as a collective in order to take advantage of economies of scale and the power of aggregation that can use energy for all, as opposed to rolling out these solutions to individual smallholders that may not be cost-effective,” said Manga.
Niyi-Afuye said there is a need to bring energy developers and agribusinesses together much earlier, aggregate demand across agricultural value chains, and structure projects around credible productive loads from the outset.
“The opportunity is to stop treating energy and food systems as two separate investment cases and start building bankable opportunities at the intersection of both,” he said.
Manga said one of the key lessons from distributed energy is that the economics are often stronger when players move away from financing individual assets for individual farmers and instead aggregate demand.
“Farmers can organise through cooperatives, producer organisations, aggregators or rural enterprises and invest in shared infrastructure that serves many producers,” he said.
“This creates economies of scale, improves asset utilisation and creates a stronger and more predictable revenue base.”
Manga said aggregation also makes these projects more attractive to financiers by reducing transaction costs and perceived risk.
“Rather than lending against hundreds of individual smallholders, investors can finance a productive asset with an identifiable operator, clear cash flows and an aggregated customer base,” he said.
Niyi-Afuye said the better model is to aggregate projects into investable portfolios, combine commercial capital with appropriate credit enhancement and risk-sharing mechanisms, and increase access to patient, local-currency financing.
“Financing infrastructure in dollars while the underlying customers earn in Nigerian Naira or Kenyan shillings creates a structural mismatch,” he said.
Pratik Patel, Bureau Chief for East and Southern Africa at AfriCatalyist, a global development advisory firm headquartered in Senegal, said a public-private-producer partnership is the model that can make renewables affordable.
“Instead of a cold storage facility or cold chain operator trying to stand alone as a single commercial enterprise, it’s embedded in a collective plan that covers the full journey from farm to table, production, aggregation through farmer cooperatives, storage, processing, and market access, with clear roles and coordination at each stage,” he said.
He said the approach matters for financing because it gives investors what a standalone facility cannot, such as a defined use case, identified long-term clients, and a credible route to market.
“When responsibility for each link in the chain is assigned to the actor best suited to manage it, the plan becomes legible and de-risked, which is what ultimately builds investor confidence,” he said.
IPS UN Bureau Report
KARACHI, Pakistan, Oct 2 2026 (IPS) - “You’re living a life drained of joy,” is how Shehnaz Sher Ali describes her “perpetually wet and stinky” existence. “I wouldn’t wish it on my worst enemy,” says the 35-year-old, who travelled by bus for more than 12 hours with her husband from their village in Rahim Yar Khan, Punjab, changing diapers whenever possible to keep the smell from reaching the fellow passengers.
For 16 years, she had lived with urine dribbling, unaware that it was treatable with a relatively simple surgical procedure.
She developed an iatrogenic fistula—caused by a surgical injury during a Caesarean section—and is among the estimated two million women living with untreated obstetric fistula worldwide.
Shehnaz got married at the age of 18 and conceived soon after. At full term, her obstetrician suspected a complication for which she underwent a Caesarean section, but the baby was stillborn. The doctor then told the young couple she would not be able to conceive again.
That was not all. She soon realized she was leaking urine.
The doctor assured her it would stop within weeks. It never did, despite three months in hospital trying to repair the leak.
“After spending so much on my operation, being told I could never have children, and then living with the urine leakage, my husband divorced me. I was damaged goods, a liability, and he didn’t want to spend any more money on me.”
She returned to her parents’ home and, a few years later, married Ali, twice her age and already married with three daughters.
“He knew about my condition but married me because he needed someone to care for his paralyzed wife and their three daughters.”
But now, her life is beginning to change.
Fistula Ward at Kooh Goth Hospital, where cats are allowed to roam free. Credit: Zofeen T. Ebrahim/IPS
Center of Hope
She is being treated at the best facility for treatment of fistula—the Koohi Goth Women’s Hospital (KGWH), run by the Zafar and Atia Foundation Charitable Trust (supported by numerous Pakistanis both abroad and within the country), in Karachi’s Landhi neighborhood.
“A relative found out about it a month back, and my husband brought me to it immediately,” she said.
Dr. Shershah Syed, who founded KGWH, was Pakistan’s first gynaecologist and obstetrician to train in genital tract fistula (both rectovaginal and vesicovaginal fistula) repair. He describes these as among the “worst and most devastating childbirth injuries” a woman can endure.
In 1993, Syed trained at Addis Ababa Fistula Hospital under renowned surgeons Dr. Reginald Hamlin and his wife, Dr. Catherine Hamlin, who provided free obstetric fistula repair in Ethiopia. Two years later, as medical superintendent of the government-run Sobhraj Maternity Hospital, he began actively repairing fistulas.
Since KGWH began operations in 2007, it has treated “more than 3,200 women and trained 30 master trainers,” said Dr. Sajjad Ahmed Siddiqui, its fistula project manager.
In 2025, UNFPA’s Asia-Pacific office designated KGWH a Regional Center of Excellence for fistula care after it trained surgeons from Bangladesh, Nepal, and Afghanistan. It was already the national referral and surgical training hub.
“We want to treat 800 women annually while providing psychosocial support, literacy, and skills training to help them reintegrate and become economically empowered,” says Dr. Jameel Ahmed, sexual and reproductive health specialist at UNFPA Pakistan. “But with global funding constraints and rising iatrogenic fistula cases, we are unsure how much reintegration support we can provide.”
KGWH’s work has also extended beyond its walls.
Syed, who is a medical advisor to the Fistula Foundation, organizes free surgical camps with the help of trained surgeons in remote Sindh government hospitals, bringing treatment to women from nearby villages.
In January, he travelled to Kabul with four female surgeons, where they set up a fistula repair camp and provided refresher training to Afghan female surgeons.
“In five days, the women surgeons repaired 20 fistulas,” said Syed. “There is a great need there, but with relations between the two countries at their lowest, it is difficult for us.”
Before the Taliban takeover, 30 to 35 women from remote provinces of Afghanistan would travel to Pakistan each year for treatment. That has now ended.
Today, there are 11 fistula repair centers across Pakistan equipped with 88 trained surgeons, and in the last decade, these centers have treated over 7,800 women for fistula.
Globally, about 50,000–100,000 new cases of vesicovaginal fistula occur each year, with 80% in developing countries, mainly in Asia and Africa, according to UNFPA. “In Pakistan, we estimate that up to 5,000 cases of fistula occur annually; iatrogenic fistula is one type,” explained Ahmed.
Back in 2007, when UNFPA began addressing obstetric fistula caused by obstructed labor in Pakistan through the Pakistan National Forum on Women’s Health, it believed that improved reproductive healthcare and more facility-based births would help reduce the incidence of this devastating condition.
Some Progress, But Not Enough
“To some extent, there have been significant improvements in maternal mortality and morbidity since then,” said Ahmed.
The progress is reflected in World Health Organization figures: Pakistan’s maternal mortality ratio fell from 276 deaths per 100,000 live births in 2006 to 155 in 2024. Neonatal mortality declined from 52 to 37.6 deaths per 1,000 live births over the same period, while the stillbirth rate fell from 39.8 per 1,000 births in 2000 to 27.5 in 2024.
But Syed remains unimpressed. Despite these gains, the toll is still “not acceptable” to him. Every day, 675 babies die before reaching one month of age, and 27 mothers die from preventable complications, amounting to more than 246,300 newborn and 9,800 maternal deaths a year. Pakistan also records more than 190,000 stillbirths annually, WHO figures show.
All these put Pakistan’s achievement of SDG 3—which deals with sexual and reproductive health—at risk.
And there is another worrying development.
As Pakistan made progress in tackling obstetric fistula, another form was emerging—one caused not by obstructed labor but by medical intervention itself. “We observed women developing fistulas following Caesarean sections or hysterectomies in health facilities—iatrogenic,” said Ahmed.
Syed is particularly concerned about this kind. “In most childbirth cases, I find surgical intervention unnecessary. Too often, the decision to intervene is a ‘personal’ one, driven by greed and ‘ease’ rather than ethics.”
“We have irrefutable proof that most of the injuries happen due to surgical error during C-sections, hysterectomies, or repair of ruptured uterus and bladder,” says Siddiqui.
UNFPA has found that a staggering 70% of fistula cases in Pakistan result from surgical injuries. “We tried to plug one hole two decades back, through improved facility-based births, and realized there was a bigger one at hand that happened in facilities that needed to be plugged now,” said Ahmed.
Dr. Pushpa Srichand, 75, has spent more than five decades as a gynaecologist and has treated some 2,200 fistula patients in hospitals, along with countless more at free surgical camps. “It is a disease of the poor; I promised myself I would never charge these women,” she said. Even after retiring from government service and joining Isra University, she made free fistula treatment a condition of her appointment.
A recent seven-year prospective study by Isra University found a 56% rise in iatrogenic fistula among gynaecological patients between 2017 and 2024. Of the 2,190 women treated for obstetric and other gynaecological complications, some 1,358 had iatrogenic fistula.
“This is a huge and extremely concerning number,” said Srichand, sharing her findings at a UNFPA national consultation that brought together regulators, medical bodies, and provincial health officials to discuss the rise in iatrogenic fistula and ways to prevent it.
Earlier research points to a similar pattern. A two-year study at Lady Willingdon Hospital, Lahore, from January 2007 to December 2008, found that 54% (33 of 61) of referred fistula cases were iatrogenic. A 2004 report from the same hospital, by contrast, found that 79% of fistulas were obstetric. The 2008 study concluded that “gynaecological surgery is being performed by untrained hands in the periphery.”
Another study at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, covering almost 12 years to June 2018, also found a rising trend in iatrogenic urogenital fistula. It concluded that the trend underscored the need for better safety standards in both obstetric and gynecological surgery.
The same was concluded at the UNFPA consultation, where doctors largely blamed inexperienced and unskilled practitioners.
“They make wrong diagnoses, perform faulty surgeries, and leave patients with lifelong complications,” Syed told IPS on the sidelines of the event.
“A C-section, for instance, is a relatively straightforward procedure,” he pointed out, but in incompetent hands, even this can go terribly wrong. “It requires a very special kind of negligent expertise to get this wrong,” he said sarcastically. He also blamed the superiors for the errors of their juniors. “They never taught their juniors properly, and many C-sections and even normal births are carried out by those without adequate training, resulting in these grave mistakes that women suffer lifelong. The worst part is there is no accountability.”
For women like Shehnaz, such medical errors are not simply complications—they can reshape an entire life.
For years, she saw her suffering as punishment for some inexplicable sin. The treatment, she says, is “Allah telling me that I have finally atoned for it.”
“When I go home, the first thing I will do is cook a large pot of biryani and distribute it among the poor, in gratitude to Allah for giving me a second life,” says Shehnaz, her face beaming after her first successful operation.
Dr. Sana Ashfaque, who carried out an “extremely complicated, four-hour-long surgery” to repair Shehnaz’s holes, is hopeful she has plugged the leak for good. “But we will keep her for another two weeks just to be sure everything is in place; she’s come from far and it may not have been easy for her to come back to us.”
After 16 years of waiting, four hours was a small price to pay for a second life.
Note: This article is brought to you by IPS Noram in collaboration with INPS Japan and Soka Gakkai International in consultative status with ECOSOC.
IPS UN Bureau Report
Oct 2 2026 (IPS) -
CIVICUS discusses life as a refugee with an exiled Sudanese civil society activist who has asked to remain anonymous for security reasons.
Over three years into Sudan’s war, millions of people have been displaced, both within the country and beyond its borders, and the numbers keep rising. Fighting continues to force civilians from their homes, while those who reach neighbouring countries struggle to find safety and stability. Civil society warns that, despite the scale of the suffering, Sudan’s crisis isn’t receiving the international attention it deserves. Exiles document violations and advocate for democracy and peace.
What drew you to human rights activism, and how has exile changed it?
The gender-based injustice women face in our societies drew me to human rights work. From childhood, I objected to the unequal treatment of girls and boys and the stereotypes that painted women as less capable. I rebelled against this system, seeking out books, stories and real-life experiences that showed women’s capabilities and potential.
Activism in exile, particularly during wartime, brings unending and unexpected risks and challenges. At times, it feels like you are fighting to survive. You carry the trauma of war and the guilt of being safe while your family and community remain in danger. Many human rights defenders lack the basic resources to survive.
In exile, I have moved from a radical stance to one focused on reform, having learned that dogmatism, hostility and refusal to listen can lead to violence and grave human rights violations. I have become more deliberate in my judgements, with a stronger desire to understand the other side.
How has Sudanese civil society adapted since the war began?
Sudanese civil society has shown remarkable resilience. People mobilised to confront the war and the collapse of state institutions. Within hours, young people and volunteers were helping the wounded, homes became field clinics and communities shared their resources.
As the war continued, many civil society organisations relocated abroad. One of the most remarkable aspects of the Sudanese experience has been the emergence of numerous additional human rights, humanitarian, women’s and youth organisations in host countries. They have maintained links with activists inside Sudan, monitored human rights and documented violations, provided humanitarian assistance, advocated for peace, promoted dialogue and countered hate speech.
Civil society’s work, inside Sudan and abroad, is one of the few sources of hope for peace in the country.
What barriers do Sudanese civil society activists and organisations face in exile?
Refugees face insecurity and a rising wave of xenophobia in host countries, and many feel unwelcome, or even blamed for seeking safety in a country where they are made to feel they don’t belong. Many also face movement restrictions, difficulties renewing residency documents and the constant risk of deportation.
On top of this, activists carry the added burden of propaganda that portrays them as fugitives or foreign agents. We must confront the abuses we document while also countering division, hatred, intolerance and racism.
Civil society organisations abroad also face economic, legal and security restrictions. Many struggle to register legally, open bank accounts, access funding or obtain permits.
Compounding all this are the limited international support and the sense that global decision-makers, and even international human rights organisations, don’t prioritise our concerns. This can leave you feeling that you simply don’t matter.
What needs to change to stop displacement silencing activists and refugees in general?
The global system often seems designed to protect the strong while weakening the vulnerable. In Africa and across the global south, we seek to change this, yet we remain constrained by the structures and assumptions of the system. We need to see difference as a source of diversity rather than division, share responsibility for resources and security, and protect everyone’s rights to life, development, dignity and freedom.
As a Sudanese refugee and human rights defender, I strongly support the Borderless Africa campaign, led by the pan-African civil society movement Africans Rising, which calls for visa-free travel and a single continental passport across Africa. It reflects the need to move beyond borders and put humanity and fundamental rights first.
It’s shocking to be forced into silence about crimes you have witnessed simply because you are a refugee. Governments, civil society and activists must dismantle the legal and logistical barriers that leave refugees unable to access basic rights.
CIVICUS interviews a wide range of civil society activists, experts and leaders to gather diverse perspectives on civil society action and current issues for publication on its CIVICUS Lens platform. The views expressed in interviews are the interviewees’ and do not necessarily reflect those of CIVICUS. Publication does not imply endorsement of interviewees or the organisations they represent.
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Sudan: blood on the hands of foreign powers CIVICUS Lens 04.Sep.2026
Sudan in crisis: mass killings continue while the world looks away CIVICUS Lens 23.Dec.2025
DOHA, Qatar, Oct 2 2026 (IPS) - In the 21st century, getting a pencil into Gaza became international news. In January, after more than two years of restrictions, UNICEF finally brought in learning kits with pencils and exercise books. Textbooks stayed out. By then, the UN had recorded damage to 97.5 per cent of Gaza’s schools.
If a pencil makes headlines, consider what a national examination demands: question papers printed for thousands of students, answer sheets scanned, halls furnished and staffed. In Gaza, education officials started by pulling damaged photocopiers from beneath the rubble, stripping their usable parts and rebuilding enough machines to keep the exam alive. It worked. More than 95,000 students have sat the Tawjihi, the national secondary school examination that decides who can compete for a university place.
This week, world leaders gathered at the UN General Assembly under the banner of “a United Nations that delivers for all“. The effort behind Gaza’s examination poses an uncomfortable question to that promise: when does celebrating a solution make it easier to tolerate the problem? Scholars writing from Gaza have warned that praising Palestinian resilience reassures outside observers and releases them from the duty to act.
At a school damaged by the war near Mashrou’ Amer in southwestern Gaza City, Education Above All Foundation and UNDP have established 10 temporary learning spaces. Credit: Education Above All Foundation
Israel classifies thousands of items as “dual-use“, spare parts among them, and bars or limits their entry. Technicians harvested parts from other machines. Repairing the printers and scanners took more than 90 days. The printers ran on old ink stocks, because new ink faced restrictions too. Until recently, paper itself could not enter Gaza.” and drop the fallback plan after it.
Exam halls also needed seats and desks. Little wood reaches Gaza. Carpenters build tables from scrap and shipping pallets, and families burn whatever they find to cook and keep warm. Staff repaired chairs and desks with timber from the pallets that carry aid. Every liter of fuel for an examination center required coordination. All of it happened under strikes that never fully stopped, which have killed more than 1,300 Palestinians in Gaza since the ceasefire took effect.
An examination also needs people. Every center needed invigilators while many education staff receive only a fraction of their salary. Before assigning anyone, the ministry first had to establish who was still alive. The war has killed more than 21,000 students and educational staff since October 2023.
A school teacher leads a lesson inside one of Gaza’s temporary learning spaces established by Education Above All Foundation and UNDP.
Credit: Education Above All Foundation
This year, Gaza’s candidates took the Tawjihi online, many on phones in tents and cafés, while the ministry worked to bring the exam back into halls. With support from the State of Qatar, Education Above All Foundation, UNDP and the ministry have set up 110 learning spaces, partly for that purpose. Planners intended these spaces, a mix of prefabricated units and tents, as a transition. Gaza’s students are using them for years, while sun, heat, humidity and cold wear them down.
Gaza’s people now crowd into less than 40 per cent of the Strip. Crews must clear rubble and check for unexploded ordnance before they can build. When they clear land for a learning space, displaced families can move onto it and stay. Others shelter in partly destroyed buildings. A school site now competes with the most basic need of all: somewhere to live.
Picture one of those 95,000 candidates. She has studied for this exam for years, first at a desk at home, then by phone light in a tent. The war has taken her father, perhaps her mother too, and most of the family who would have waited for her results. She may walk on crutches where a leg used to be. Strikes still fall at night, and she revises anyway. All she wants is the chance to sit the exam. Behind that chance stand a salvaged photocopier, a rebuilt desk and a negotiated liter of fuel, each one liable to fail. The UN reports that shortages once managed through reuse have become unmanageable, and critical systems are failing. Judged against a cancelled examination, against a school able to order a replacement part, it reveals an avoidable burden.
I am from Gaza, and I work for one of the foundations that funds this response. That makes the question personal: have we become so used to celebrating what Palestinians can salvage that we no longer ask why they must salvage it? An examination held amid continuing strikes is an achievement. It is also evidence of a world that has allowed the conditions for education to be dismantled.
As the speeches in New York wind down, leaders can measure their words against practical tests. Let paper, printer parts, school furniture and textbooks into Gaza without months of negotiation. Fund classrooms built to last years, not seasons. Pay the teachers who keep the system running. Gaza’s educators have shown what they will do to keep education alive. The question before the world is what it would take for Gaza’s schools to stop needing miracles.
Hani Shehada, Palestinian from the Gaza Strip, and is Regional Manager at Education Above All Foundation’s Al Fakhoora programme.
IPS UN Bureau
Excerpt:
Gaza's educators rebuilt photocopiers from rubble to keep a national exam alive. As world leaders wrap up their week in New York, they should count what that feat cost.
NEW YORK, Oct 2 2026 (IPS) - In November 1952, the United States detonated the world’s first thermonuclear device at Enewetak Atoll in the Marshall Islands. The test, code-named Ivy Mike, erased the island of Elugelab and scattered a signature of plutonium across the planet that remains in lake beds, ice sheets and ocean sediments today.
This month, scientists writing in Nature Reviews Earth & Environment proposed this moment as the start of the Anthropocene, a geological epoch shaped by human activity. Co-author Victor Galaz of the Stockholm Resilience Centre called the date “a tragic reminder of the highly unjust impacts of planetary change.”
I take that proposal seriously, because it carries hope as well as warning, and it connects to the argument of my new book, Whole Earth Farming.
Hugh Locke
The idea of the Anthropocene was popularized in 2000 by Nobel laureate Paul Crutzen. In 2020, a paper in Nature found that human-made materials now outweigh all living things on Earth. Yet in 2024, the International Union of Geological Sciences declined to formally recognize the Anthropocene. Officially, we are still in the Holocene.
The new paper, led by Jan Zalasiewicz, Colin Waters and Martin J. Head, draws on 12 stratigraphic records worldwide and identifies the 1952 rise in plutonium as the clearest marker of the new epoch. Whatever the geologists decide, the substance stands: human beings have become a force of planetary consequence.
Nobody set out to launch a new geological epoch. The Anthropocene is the unintended result of billions of decisions about energy, industry, consumption and land use. That is sobering. It is also, strangely, encouraging.
If humanity can alter the chemistry of the atmosphere without meaning to, then we are clearly capable of transformation at planetary scale. The only question is whether we can do it on purpose, in a direction that heals rather than harms.
Galaz’s point about injustice matters too. The Marshall Islanders had no say in what happened at Enewetak, yet bore its consequences. Those who contributed least to planetary change are often hit hardest, among them the world’s smallholder farmers. Any real transformation must put them at the center.
There are some 475 million smallholder farming families in the world, roughly one quarter of humanity, and yet they are largely absent from conversations about the future of food and climate.
Whole Earth Farming argues that these families could lead an agricultural revolution. It draws on 21 farmer stories from 18 countries and on decades of work, including in Haiti, where I co-founded the Smallholder Farmers Alliance. Its central argument is that if half the world’s smallholders adopted regenerative practices, they could produce all the additional food needed by 2050 while reducing agriculture’s net climate impact.
There is a fitting symmetry here. The Holocene began with a climate stable enough for humans to start farming. The Anthropocene could likewise coincide with a new global agricultural movement, one that restores the land rather than depleting it.
The changes of the 1950s spread without any global plan, as new tools and habits moved from place to place until they gathered their own momentum. A regenerative transformation can spread the same way: through practices that work, farmers who see them working on a neighbor’s land, and the support to adopt them.
The farmers in the book are already rebuilding soil, planting trees alongside crops and restoring water cycles. What they lack is not ingenuity but recognition, investment and connection to one another.
I once suggested that the historical epoch now taking shape will one day be named for the moment we began to reorganize ourselves around the principle of oneness. I still believe that.
The Anthropocene is, in one sense, the geological record of our failure to see ourselves as one people sharing one planet. A regenerative transformation led by smallholders would be the opposite: a practical expression of oneness, rooted in the recognition that the health of the land, the wellbeing of the farmer and the future of humanity are inseparable.
If a single morning in 1952 can mark a new chapter in the Earth’s geological history, then surely the choices of hundreds of millions of farming families can mark a new chapter in human history. We have already proven that we can change the planet. Now it is time to prove that we can do so with intention, with justice, and with the whole Earth in mind.
Hugh Locke is president and co-founder of the Smallholder Farmers Alliance, president of the Impact Farming Foundation and author of Whole Earth Farming: Smallholders and the Great Regenerative Transformation (George Ronald Publisher, 2026).
IPS UN Bureau
Excerpt:
What a 1952 bomb test tells us about the power of 475 million farming families
KUALA LUMPUR, Oct 1 2026 (IPS) - Nurses are often called the backbone of the health system. We praise their compassion, commitment and resilience. On Nurses’ Day we thank them. During emergencies and crises, we call them heroes. But there is a harder question Malaysia, like most countries around the world, needs to ask more seriously: what happens when the people who care for everyone else are not safe, supported or respected at work?
This question is not only about patient safety. It is first about nurses’ own rights, dignity and wellbeing. A safe and healthy working environment is recognised by the ILO as a fundamental principle and right at work.
Nurses deserve safe workplaces not only because patients depend on them, but because no worker should be expected to absorb abuse, bullying or harassment as part of the job.
The health and care sector is highly feminised, with women making up around 70% of the global workforce. This is even more pronounced in nursing, where women account for 85% of the workforce, according to WHO’s 2025 State of the World’s Nursing report. This means workplace violence against nurses is not only an occupational safety concern. It is also a gendered issue.
As a female-dominated profession, nursing is often positioned lower in hierarchical health systems, where authority is unevenly distributed. Gendered assumptions - such as women being “naturally caring,” patient or obedient - can normalise mistreatment, silence complaints and discourage reporting
As a female-dominated profession, nursing is often positioned lower in hierarchical health systems, where authority is unevenly distributed. Gendered assumptions – such as women being “naturally caring,” patient or obedient – can normalise mistreatment, silence complaints and discourage reporting.
Because nurses are also frontline caregivers, they are exposed to aggression from patients, families and colleagues. Gender therefore shapes both how violence is experienced and how seriously it is taken.
For many nurses and frontline health workers, workplace violence extends beyond physical assault. It involves verbal abuse, bullying, humiliation, intimidation, sexual harassment, disrespectful treatment, harsh hierarchy and psychological pressure.
These forms of violence may not always leave visible injuries. But they can leave deep marks on confidence, mental health, family life, professional motivation and the decision to stay in the nursing profession.
Studies from several Malaysian healthcare settings show that workplace violence is more common than we may think across hospitals, emergency departments and primary healthcare facilities.
A study conducted among 90 nurses in Kuala Lumpur found that more than 90% had experienced verbal abuse. Similarly, a survey of 838 primary healthcare workers in Selangor reported that 68.5% had experienced workplace violence, with verbal abuse the most common form and nurses the most affected professional group. In Melaka, research among 455 female registered nurses found that 51.2% had experienced sexual harassment, most commonly verbal, but also visual, psychological, non-verbal and physical. Nearly three-quarters of those affected reported psychological effects.
Behind each of these figures is a person trying to do their job while staying calm, professional and compassionate. A nurse explaining treatment to an anxious family. A frontline worker managing a crowded clinic. A junior staff member afraid to speak up. A mother finishing a night shift and going home to another set of care responsibilities. These numbers should not be read as statistics alone. Rather, they are warning signs of workplace systems and cultures and the need for stronger prevention, reporting and response mechanisms.
Malaysia already has important foundations in place. Existing occupational safety and health obligations, together with MOH guidance on workplace violence, provide a strong basis for prevention and response. The challenge now is to build on these measures and ensure they are visible, trusted and consistently implemented in hospitals, clinics and frontline services.
This concern was clearly articulated in a focus group discussion with nurses and frontline health workers in Sabah. Participants described workplace violence and bullying as part of a wider picture of pressure: too many patients, too few staff, missed breaks, unpaid or poorly compensated overtime, limited recognition, burnout and difficulty balancing shift work with family responsibilities.
One district clinic was described as seeing around 600 to 800 patients a day, with only a small number of frontline staff managing the flow. In hospital wards, nurses described caring for 10 to 20 patients and sometimes up to 25 patients alone. Staff often missed lunch breaks, stayed beyond official hours to complete patient care and documentation and sometimes worked while sick because no one else was available to replace them. Heavy documentation and uneven digital systems added another layer of pressure.
In the same Sabah discussion, one participant described bullying as something that particularly affects newcomers and junior staff. Another explained that many young workers feel they have little choice but to endure difficult treatment because they need the job. As one participant put it, many feel they must “just bear with it” because speaking up can feel risky.
The human cost also reaches beyond the workplace. One nurse described leaving for work while her children were still sleeping and returning home when they were already asleep again. This is not only a personal story. It is a policy issue. When nurses are overworked, unheard or afraid to speak up, safety, dignity, learning and retention all suffer.
This is why workplace violence must be discussed together with Malaysia’s nursing shortages, retention concerns and migration of nurses. Nurses do not leave only because of salary, although salary and fair compensation matter greatly. They also leave when they feel unsafe, unheard, unsupported and unable to grow.
When nurses feel unable to speak up, silence becomes part of the system. When junior staff are humiliated instead of mentored, learning suffers. When bullying becomes normalised, workers may begin to see leaving as the only realistic option. For a mostly female workforce, these pressures do not affect nurses alone. They also affect families, communities and how society values care work.
Training more nurses will not solve the problem if the working environment pushes nurses away. The real question is not only how we produce more nurses, but also how we ensure that nurses can stay, work safely and be treated with dignity. A serious response to workplace violence in healthcare should include several practical steps.
First, nurses should have a stronger voice in decisions that affect their work. Frontline nurses, nursing leaders, professional bodies and unions should be meaningfully involved in shaping policies on staffing, workplace safety, reporting systems, mental health support, digitalisation and service delivery. Collective representation matters because individual nurses should not have to carry the burden of speaking up alone.
Second, trusted systems for preventing, reporting and responding to workplace violence, bullying and harassment should continue to be strengthened. Nurses need to know they can safely report any kind of violence without fear of being ignored, blamed or punished. Too often, incidents go unreported because people do not believe anything will change. A safe workplace starts with systems that people trust.
Third, addressing staffing shortages and excessive workloads is also essential. When nurses are caring for too many patients, missing breaks and regularly staying late to finish their work, everyone pays the price. Safe staffing is not a luxury. It is essential for both patient care and health worker wellbeing.
Fourth, supporting nurses also means looking beyond individual resilience. Nurses need time to rest, supportive supervisors, access to mental health support and workplaces where people treat each other with respect. Supportive mentoring and teamwork can make a real difference – especially for junior staff and newcomers.
Finally, workplace safety needs to be considered alongside career development, fair compensation and better systems. Nurses need fair recognition for overtime and workload, opportunities for specialisation and higher education, and digital systems that reduce administrative burden rather than adding to it.
Ultimately, this is about recognising that nurses are not an endless resource. They are people, often women, who care for others every day while carrying their own pressures, responsibilities and challenges. Ensuring their safety, dignity and wellbeing is not only the right thing to do. It is a smart investment in a stronger and more resilient health system.
Malaysia has an opportunity to build on the measures already in place and further strengthen workplace safety, staffing, support and working conditions. Everywhere in the world, health systems depend on nurses at every stage of life – from birth to old age, from routine check-ups to medical emergencies. Malaysia is no exception.
Safe patients need safe nurses. And safe nurses need workplaces where respect, dignity and rights are non-negotiable.
By Johanna Riha, Sergo Chikhladze, Sapna Mishra (UNU Global health) and Nicholas Hulus (Sabah Medical Services Union (SMSU))