Dear colleagues,
Good morning from Cairo, Egypt.
11 November 2024 - Since our last briefing on health emergencies, the conflict we feared would escalate has intensified, leading to a devastating deterioration in the Middle East, particularly in the occupied Palestinian territory and Lebanon.
The Famine Review Committee has warned of imminent famine in North Gaza and 15 UN agency leaders have described the situation there as “apocalyptic". Yet, tragically, nothing has changed – and perhaps has only become worse.
Amid this relentless violence, we are working tirelessly to keep hospitals operational and evacuate patients in need of specialized care. In the largest medical evacuation since October 2023, WHO and partners facilitated the transfer of 90 patients and 139 companions to the UAE and Romania, with 84 patients and 124 companions transferred to the UAE.
WHO has consistently advocated for medical evacuations throughout the hostilities. While every patient’s safe evacuation is a success, it is important to remember that each evacuation means patients and companions crossing borders, leaving behind what is left of their homes and communities, their family and friends trapped in a war –loved ones they may never see again.
The trauma and emotional toll of this conflict are immeasurable.
In the past 3 weeks, WHO and partners have completed 7 missions to North Gaza, including 5 to Kamal Adwan Hospital. Several more were planned but not facilitated. During these missions, our teams delivered essential medical and surgical supplies to sustain hospital operations. On one of these missions, heavy bombardment continued close to where our teams were delivering aid.
There is truly no safe place in Gaza.
In a tremendous achievement, the second round of the polio vaccination campaign in the Gaza Strip was completed last week, with over 500 000 children under 10 vaccinated with a second dose. The campaign succeeded against unimaginable odds, with planned humanitarian pauses significantly curtailed. This speaks to the incredible courage of polio teams, parents and caregivers who pursue health and hope in the face of despair.
It is not possible to discuss Gaza without acknowledging the indispensable role of UNRWA in delivering critical services. As the World Health Organization's Director-General has emphasized, there is no substitute for UNRWA. I want to take this moment to recognize the dedication of UNRWA staff — health and humanitarian professionals working tirelessly for their communities under unimaginable circumstances. Our work, and the work of other humanitarian partners in the occupied Palestinian territory would not be possible without them.
In Lebanon, the situation is equally distressing, with health facilities under sustained attack. Since 8 October last year WHO has verified 103 attacks on health care.
As of today, 17 hospitals in Lebanon have either ceased operations or are only functioning partially due to insecurity or damage to infrastructure. In areas of active hostilities, an estimated 127 – nearly 60% – of primary health care centres and dispensaries have been forced to close.
This systemic disruption of health care is an increasingly disturbing trend, impacting the present and future of entire populations. It is a stark violation of international humanitarian law.
We cannot — and must not — allow this to become a norm.
In preparation for the heavy burden of traumatic injuries, over 5500 health workers across more than 112 hospitals in Lebanon have received advanced training in mass casualty management and psychological first aid. WHO has also delivered 124 metric tons of medical supplies, including a 3-month stock of blood bank supplies and trauma-kits for 45 priority hospitals.
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Let me turn to Sudan. That every second Sudanese —around 25 million people — requires humanitarian aid is a harrowing reality. In this agriculturally rich land people are enduring the world’s largest hunger crisis. The humanitarian catastrophe in Sudan is beyond measure.
I am particularly concerned about the situation in Al Jazirah state which has deteriorated rapidly due to intense fighting during recent weeks. Hunger has intensified, health facilities have been attacked and there are reports of mass rapes and killings. Every health facility in East Jazirah has been attacked. Among the many lives lost are the only female doctor in the area and a dialysis centre biomedical engineer. WHO medical supplies and ambulances have been supporting with immediate assistance, including trauma care and emergency surgeries for casualties as well as for disease outbreak surveillance and response.
We are working closely with partners to monitor and contain the cholera outbreak in Sudan, supporting the deployment of millions of oral cholera vaccines across multiple states. We have set up 12 cholera treatment units and 48 oral rehydration points and have donated critical treatment supplies to the Ministry of Health and partners like Médecins Sans Frontières running other treatment centres.
Despite the immense challenges facing Sudan, I am proud to share that it has become the first country in the Eastern Mediterranean Region to launch one of the new malaria vaccines — an essential step in fighting one of the world’s deadliest diseases that kills nearly half a million children under the age of 5 each year in Africa.
The opening of the Adre crossing with Chad has enabled a flow of lifesaving medical supplies to Darfur, where needs remain enormous amid persistent conflict, hunger and disease. We are deeply concerned about plans to close the Adre border, a lifeline for hundreds of thousands trapped in Darfur. We urge the Sudanese authorities to reconsider this decision for the sake of people who have already lived through unimaginable pain.
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As we discuss countries enduring grave crises, I want us to remember those which are often overlooked. During recent visits to Somalia and Djibouti, I witnessed first-hand the resilience of these often forgotten populations.
In Somalia, I saw a country at a crossroads. Decades of conflict, compounded by extreme weather and disease outbreaks, have left their mark, yet there is powerful commitment to change. Health infrastructure is devastated, with more than 40% of Somalis lacking basic services. Hearing of children who have never had a single vaccine, and visiting hospitals struggling to serve mothers and newborns, underscored the gaps we must address together.
I am especially grateful for the government’s drive to end polio and strengthen health services through the National Transformation Plan, a vision that aligns closely with WHO's regional priorities for building a skilled health workforce, improving access to essential medicines and reinforcing health infrastructure. This work is complex and, at times, daunting, but with continued support from our partners I believe we can make lasting progress.
Djibouti, too, is making strides despite the odds. I was inspired by the government’s commitment to universal health coverage, even as it grapples with pressures from climate change and migration which place significant strains on health services.
Djibouti’s position as a key transit point means it faces unique public health challenges. I visited centres where dedicated staff provide health care services to migrants and local communities alike, often under extremely trying conditions. With rising noncommunicable diseases like diabetes and hypertension, Djibouti is working to strengthen primary care, and I am encouraged by their drive to build a health system that serves everyone. WHO will support this journey, by addressing workforce gaps and advocating for sustainable health financing to help Djibouti reduce reliance on external aid.
After meeting with leaders, health workers and humanitarian partners in both countries, I ended my visits with a sense of determination. Somalia and Djibouti may face different challenges, but the resilience of their people is striking. I am committed to amplifying their voices and calling for sustained support. WHO stands with the people of Somalia, Djibouti and all those affected by crises that the world seems to have forgotten. Despite the challenges, we are bringing health services closer to those in need, building resilient systems and ensuring that every person has the chance for a healthier future. I urge the international community to join us in our mission.
Before I close, I want to reaffirm WHO’s key asks for the Eastern Mediterranean Region:
We urgently call for immediate and sustained ceasefires in the occupied Palestinian territory, Lebanon and Sudan, and unhindered access to deliver lifesaving aid.
We demand the protection of civilians, health care workers and health facilities at all times, in all countries facing humanitarian and health emergencies.
And we ask that the world remembers every community in need — from Afghanistan to Syria, Yemen, the occupied Palestinian territory, Somalia and Sudan — and stands with us in our humanitarian mission to serve them.
Thank you.
