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Scoop
28-06-2025
- Health
- Scoop
Gender Equality And Human Rights Are Indivisible, Foundational And Unconditional
"When human rights are treated like an 'à la carte menu' by governments, and not what they truly are - indivisible, foundational and unconditional... we move fast into dystopia," said Dr Tlaleng Mofokeng, United Nations (UN) Special Rapporteur on Right To Health. "We saw during COVID-19 lockdown time that people who were from the most marginalised groups, were furthest pushed behind. These included: peoples from gender diverse communities, women in all diversities, women in sex work, women who use drugs, or young girls, for whom there was hardly any access to care, support and services. Gender-based violence was being more reported during the pandemic. We have learnt the harder way that how we want to ensure marginalised people are included in strengthening the health systems and making them resilient in gender-transformative manner," said Dr Harjyot Khosa, Regional External Relations Director, International Planned Parenthood Federation (IPPF) and member of Civil Society Engagement Mechanism for UHC 2030. "We need to engage marginalised communities in all their diversities to adapt and redesign health systems to better protect them within the framework of universal health coverage," Dr Khosa added. She was speaking at a special Side Event alongside 78th World Health Assembly organised by Global Centre for Health Diplomacy and Inclusion (CeHDI), International Planned Parenthood Federation, Fos Feminista, CNS, and partners. Are health systems designed for gender diverse peoples? Dr Harjyot Khosa reminded that health systems are defined and designed for heterosexual married people, like 'good couples' as per the harmful social norms rooted in patriarchy. 'So, perception and level of stigma and misogyny within healthcare systems is what we all grapple with every day. Sexual and reproductive health, rights and justice has to be the first push to deliver on UHC at all levels,' she said. "Just because of the colour of your skin, people become a victim of sexual assault. When they go the police, they are turned away because they are 'not citizens of the country.' Or a woman is denied mental healthcare because of language barriers. These are the realities I face daily in Dominican Republic,' said Dr Eliezer Lappots-Abreu, Executive Director, Health Horizons International, Dominican Republic. "Although we live in Dominican Republic where health access and universal health coverage is part of the norm, but it is not accessible for everybody because it excludes women of colour and immigrants. One of my patients, a Haitian woman, was diagnosed with cervical cancer but when we connected her to services to treat her cancer, she was turned away because of the language barrier. When we arranged a translator for her, we were told that they can understand her but unable to serve her without documentation. Patient wondered if her options was to get palliative care or just die in the house,' he added. UHC is not about coverage alone but Universal Health Care 'It is not accidental that 'C' in 'UHC' (Universal Health Coverage) stands for 'coverage' in the official language but it should be about Care – Universal Health Care. No wonder due to governments focussing on UHC, or coverage, we see increasing space for 'health insurance.' Universal Health Care (and not Universal Health Coverage) better links us with the spirit of Alma Mata Declaration of 1978 (which heralded WHO led call to deliver on Health For All),' said Baba Aye, Health and Social Services Officer, Public Services International (PSI), who earlier worked for two decades in the Medical and Health Workers Union of Nigeria. "We cannot talk of universal health care without health workers for all," said Baba Aye of PSI. He said that when 13% of maternal mortality are from unsafe abortions, and two-thirds of healthcare workers are women themselves, imagine the struggle in countries where abortion is criminalised. Connect the dots: Leprosy, gender justice, human rights, and SDGs Leprosy (also known as Hansen's disease), once feared as an incurable disease, is now treatable with modern medicine. When diagnosed early and accurately, and treated early with right medicines, it is not disabling too. But leprosy-related stigma and discrimination continues to cause havoc in lives of people affected with leprosy and blocks access to care even today. But only when we put leprosy under gender lens, we get to see the alarming inter-sectional stigma and discrimination that impacts women with leprosy. 'Women with leprosy face unique and often invisible struggles. At home, they are often unable to express their problems, even to other women. This is not the case for men. In family matters, whether it is making decisions or purchasing essentials, women are frequently excluded. Gender discrimination plays a major role here,' said Maya Ranavare, President of Association of People Affected by Leprosy. 'Women with leprosy receive lower wages than men for the same work, which is a clear example of gender inequality. These issues are compounded by the stigma of leprosy. But perhaps the most serious impact is in the area of healthcare. Women with leprosy often suffer in silence. Social stigma, economic dependence, and a lack of agency prevent them from seeking timely medical help or sharing their experiences. This intersection of gender and disease requires urgent attention. If we want to truly support people affected by leprosy, we must also address the gender-based injustices they face every day,' she added. 'We need to ensure people living with HIV are covered under UHC (under Indian government's health insurance). Although government of India has done a commendable job in ensuring people living with HIV receive lifesaving antiretroviral therapy and support at government-run healthcare facilities across the country, there are other healthcare needs too which people face - and often have to pay. Out-of-pocket expenses often become catastrophic costs for people with HIV, especially women who face inter-sectional stigma and discrimination at all levels,' said Daxa Patel, co-founder and former President of National Coalition of People Living with HIV in India (NCPI Plus) and leader of Gujarat State Network of People living with HIV (GSNP Plus). Gender inequality and violation of rights exacerbate during conflicts and humanitarian crises Parwen Hussaini of Afghanistan is at risk of her life along with her lesbian lover Maryam (Maryam is under arrest). Parwen was born in Gazhni province of Afghanistan and identifies as a lesbian and Afghan. She narrowly escaped persecution and arrest by the Taliban on 20th March 2025 and she is now in Iran. Parwen and her lover were engaged to get married when they tried to escape. Her lover (Maryam) is being tortured and imprisoned by the Taliban and in prison for over one and a half months (as on 10 May 2025). Nemat Sadat, CEO of 'Roshaniya' (an advocacy network dedicated to assisting LGBTQI+ Afghans) and one of the first Afghans to have openly come out as gay person and to campaign for rights, gender freedom and liberty, said: 'We have a list of over 1,000 LGBTQI+ peoples who still remain in Afghanistan. To this date, we have supported the safe evacuation of 265 people to different countries and we hope that Parwen will also get to a safe place.' 'The ongoing conflict in South Sudan has disempowered a lot of excluded and marginalised peoples including women, LGBTQI+, people living with HIV, persons with disabilities, sex workers, among others. So, when it comes to gender justice the issue of gender-based violence becomes central. There is physical violence, domestic violence, and sexual harassment and sexual abuse. They are raping women rampantly. Due to the conflict there is also increased risk for the displacement of women and girls in South Sudan (which puts them at greater risk of violence). There is also limited access to justice and support for young women, women with disability, and people with HIV because of their condition,' said Rachel Adau, Executive Director of the Women's Empowerment Centre South Sudan. Let us hope that at the upcoming UN intergovernmental High Level Political Forum where UN Sustainable Development Goals for health (SDG3) and gender equality (SDG5) are under review, governments commit to get on track to deliver on all SDG goals and targets. We cannot 'pick and choose' rather deliver on all SDGs. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
New York Times
15-05-2025
- Health
- New York Times
Malcolm Potts, Irreverent Evangelist for Contraception, Dies at 90
Malcolm Potts, a physician, reproductive scientist and contraceptive evangelist who helped develop and promote the device most frequently used to perform surgical abortions, and who spent more than half a century directing programs that provide reproductive health services to women in developing countries, died on April 25 at his home in Berkeley, Calif. He was 90. The cause was Alzheimer's disease, said his stepdaughter, Madison Iler. Although he didn't identify himself as such, Dr. Potts was essentially a neo-Malthusian. Like Thomas Robert Malthus, the economist of the late 18th and early 19th centuries. he saw population control as critical to preventing war, famine and environmental collapse, particularly in Africa, where for decades he oversaw women's health programs, first as medical director of the International Planned Parenthood Federation and then as president of Family Health International, another global organization. He felt that women's ability to control their own reproductive lives was crucial to that aim — an enormous challenge in the conservative countries he served. 'Malcolm felt we were heading for catastrophe if we didn't do a better job in family planning,' said Stefano Bertozzi, a former dean at the University of California, Berkeley School of Public Health, where Dr. Potts held an endowed chair in population and family planning. The two met when they were working on H.I.V. prevention in Africa for different organizations. 'He was a ferocious ally for women having unfettered access to the tools they needed to manage their own fertility,' Dr. Bertozzi said in an interview. The British-born Dr. Potts was rumpled, tweedy and irreverent. He was of a generation that did not pander to political correctness, and he had a collection of ties printed with condoms. He was also one of Berkeley's most popular professors. His classes on human sexuality, at which he dispensed policy points, naughty anecdotes and common sense, were filled to overflowing. Dr. Bertozzi called him the Bernie Sanders of Berkeley. 'He was the biggest feminist I ever met — and the most unlikely,' said Alisha Graves, a public-health policy expert and former student of Dr. Potts's. Together the two of them founded OASIS (the initials stand for Organizing to Advance Solutions in the Sahel), an organization that serves women in the Sahel, a region just below the Sahara that encompasses 10 countries and has been battered by climate change, poverty and high rates of fertility — as well as its terrible byproduct, maternal mortality. Dr. Potts's focus was global, but his first brush with the fallout from unwanted pregnancies happened at home. A newly minted obstetrician, he was fresh out of medical school at the University of Cambridge when he was posted to a busy hospital in North London. There, he regularly treated women suffering from incomplete abortions — meaning that they were still pregnant, but losing blood. It was the early 1960s, abortion was not yet legal in England, and, Dr. Potts said, the experience was an epiphany. He opened a clinic to provide contraception to single women and vasectomies to men. And he joined a lobbying group of medical professionals working for the legalization of abortion in Britain, which happened in 1967. Dr. Potts became a well-known booster of oral contraceptives; he once told a newspaper reporter that the Pill was so safe, he would give it to his 2-year-old daughter. He famously appeared on David Frost's late-1960s talk show, 'The Frost Programme,' to debate the merits of oral contraceptives with a conservative gynecologist. The gynecologist averred that they were so dangerous, he would prescribe them only to prostitutes. Dr. Potts responded by pouring a bag of rice onto a table and picking out two grains, to indicate the percentage of women at risk of death from taking birth control pills. He then counted out 27 grains to illustrate the percentage of women at risk of dying from an unintended pregnancy. 'It would be a service to mankind if the Pill were available in vending machines and cigarettes were placed on prescription,' Dr. Potts told Reader's Digest in 1969. (It was a sign of the times that cigarettes were then sold in vending machines, like candy.) In 1968, Dr. Potts became the medical director of the International Planned Parenthood Federation. In that position, he saw firsthand how the low status of women in poor countries led to harsh outcomes in their reproductive health. He began to research ways to provide safe abortions in places where medical care was delivered in less-than-optimal conditions. He read about Harvey Karman, an eccentric activist and psychologist in training at the University of California, Los Angeles, who had come up with a way of performing abortions that was safer and less painful than what was then the more frequently used method, dilation and curettage. Vacuum extraction, as the technique is called, is now the most common surgical procedure for ending a pregnancy. Dr. Potts sought out Mr. Karman, and together they refined the device he invented to perform vacuum extraction. They wrote about it for The Lancet, the British medical journal, whose editors were unaware that Dr. Potts's co-author was not a medical doctor. Dr. Potts received a grant from the United States Agency for International Development to provide the device to International Planned Parenthood Federation clinics around the world. In 1972, the two men brought the device to Bangladesh, where they were part of a team of medical professionals invited by the government to perform abortions on rape victims and to train local doctors in the procedure. (Some 1,500 women and girls, many as young as 10 years old, had been raped by Pakistani soldiers during the Indo-Pakistan war of 1971, when Bangladesh won its independence.) In India, Dr. Potts traveled to Mumbai (then known as Bombay) to provide vasectomies; he set up a clinic on a train station platform because men there were fearful of hospitals. In Thailand, he organized a community-based distribution system of birth control pills and condoms, training market vendors, shopkeepers, schoolteachers and one undertaker to dispense them properly. A decade ago, Dr. Potts started a company called Cadence with Nap Hosang, an obstetrician who was his colleague at Berkeley, and Samantha Miller, a pharmaceutical industry veteran, to produce a birth control pill that could be sold without a prescription. After years of holdups by the Food and Drug Administration, exacerbated in recent months by layoffs at the agency, it has yet to be approved. Zena, as it's called, is a combination progesterone-estrogen pill that carries a low risk of blood clots. (An online questionnaire, should the pill receive the go-ahead, would evaluate each woman's risk.) The company has been more successful with its Morning After Pill, which is sold online, in convenience stores like 7-Eleven and in vending machines on college campuses. David Malcolm Potts was born on Jan. 8, 1935, in Sunderland, England, the youngest of three sons of Kathleen (Cole) Potts and Ronald Windle Potts. He grew up in Newcastle and attended Cambridge, where he earned his medical degree and a Ph.D. in embryology. Dr. Potts was married four times. His marriages to Dera Joyce Cook and Caroline Merula Deys ended in divorce. His third wife, Marcia Jaffe Potts, died in 1993. His fourth wife, Martha Madison Campbell, died in 2022. In addition to Ms. Iler, his stepdaughter, Dr. Potts is survived by a son, Oliver Macdonald, from his first marriage; a daughter, Sarah Deyes Longlands, and a son, Henry Potts, from his second; a daughter, Sandra Potts Jaffe, from his third; two stepsons, Douglas Iler and Bruce Iler; seven grandchildren; and four great-grandchildren. Dr. Potts was the author of a number of books — not only practical textbooks on contraception, but also quirkier fare, including 'Queen Victoria's Gene: Haemophilia and the Royal Family' (1995), written with his brother William, which suggested that Queen Victoria had been illegitimate. They noted that none of her ancestors had possessed the genetic mutation for hemophilia, which she famously passed along to royalty throughout Europe. Therefore, they argued, her father could not have been Prince Edward. When the book came out, Dr. Potts told The Sunday Times of London that he thought Queen Victoria's body should be exhumed for DNA testing to settle the matter. A spokesman for the royal family responded, 'I don't think there's been any attempt ever to dig up members of the royal family.' 'Sex and War: How Biology Explains Warfare and Terrorism and Offers a Path to a Safer World' (2008), which Dr. Potts wrote with Thomas Hayden, a journalist, explored what they called the male predisposition to team aggression, tracing it from prehistory and primatology to current horrors. Educating women and girls to increase the number of women in leadership roles was one of their suggestions for a way to 'help make peace break out.' 'Peace needs strong allies in order to persist,' they wrote, 'and the ally that has been the most consistently overlooked is the one that makes up slightly over half the human race — women.'
The Guardian
02-03-2025
- Business
- The Guardian
‘This will cost lives': cuts to UK aid budget condemned as ‘betrayal' by international development groups
Keir Starmer promised at the UN last September that the UK would 'be a leading contributor to development'. Just five months later few expected an announcement that could result in UK aid spending falling to its lowest level this century. Overseas development aid will fall from 0.5% of the UK's gross national income to 0.3% – a cut of about £6bn – in order to pay for increased defence spending. The cut will have dire consequences, according to the groups delivering much of that aid. Describing it as a betrayal of poorer countries, Dr Alvaro Bermejo, director general of the International Planned Parenthood Federation, says: 'This will cost lives.' Anneliese Dodds, the international development minister, resigned over the decision on Friday. UK aid funds projects offering humanitarian assistance and health services, as well as work with communities suffering the frontline effects of the climate crisis and conflict. The announcement follows the Trump administration's sweeping cuts to US aid, which, among other crushing effects on the world's poorest people, have resulted in abrupt halts to life-saving HIV drug programmes in many parts of sub-Saharan Africa. Humanitarian work in refugee camps, hospitals and healthcare centres has stopped in many of the 177 countries helped by USAid, while funding for groups working on the frontline of the climate crisis has vanished. Human rights and independent journalism organisations also face closure. It is also part of a wider trend – a pattern of cuts to aid spending in countries that have historically been leading donors, including Germany, France, Belgium and the Netherlands. Canada looks as if it will follow suit, if its Conservative party wins forthcoming elections. The scale and speed of the cuts now facing the sector is unprecedented, and decisions made in response will have wide-ranging implications for global health and security for generations to come. Neither philanthropy nor domestic funding within countries receiving the aid is likely to be able to fill the vast gaps left as western countries withdraw. Jean-Michel Grand, director of Action Against Hunger UK, says the world is seeing a 'radical politicisation of aid' in which it was talked about in terms of trade, prosperity and security, with 'the whole ambition of addressing poverty very secondary and not even mentioned'. Internationally agreed norms, such as respect for humanitarian laws or agreement on important development targets, are at stake, says Grand. And the shift posed ethical questions for aid organisations, he adds. 'What are the conditions that are going to be attached to getting a grant [in the future]?' Since 1970, the UN has set a target for countries to spend 0.7% of their gross national income on overseas development assistance. The target has since been accepted by successive British governments and, after a surge in investment during the Blair and Brown years, was achieved by the UK in 2013 for the first time, and made a statutory duty in 2015. The British public still cares, says Grand, pointing to generous donations to Disasters Emergency Committee appeals. But aid has become an 'easy target', with political rhetoric that 'leads to some doubts within the public about how useful or impactful aid is. 'Clearly, none of these decisions, whether the British, the American, the German, could have happened if there would have been a political risk for the government,' says Grand. Aid organisations must take some responsibility for failing to make the case, he says. Now the sector will need to 'rethink … the aid structure that we want to have, the role of international NGOs, and what are we standing for', he says. 'What happens to the international NGOs, etc – that is not the most important thing. What is important is more the goal – how are we going to alleviate poverty, malnutrition, and how are we going to try to mitigate the risk of future conflict, because of poverty, because of hunger, because of climate change? And it's not by disinvesting.' The volte-face by the US and others not only causes financial issues for NGOs, but damages delicate relationships built up over years, Grand says. In 2021, Boris Johnson's Tory government reduced spending to 0.5%, with parliament voting that the 0.7% commitment could be suspended until certain fiscal tests were met. An impact assessment at the time conceded that those cuts would mean thousands of deaths, including of malnourished or unvaccinated children, and women left without safe abortion services. In its manifesto, and repeatedly in power, Labour had promised to restore spending to 0.7% 'as soon as fiscal circumstances allow'. It insists that commitment is still true. However, in recent years, UK governments have been spending about 40% of the aid budget in the UK itself to cover housing and administrative costs for refugees. 'The lowest ever share of income the UK spent on international aid was in 1999, at 0.24%,' says Ian Mitchell, senior policy fellow at the Center for Global Development. However, at that time, 'we didn't used to count refugee costs in aid'. Even if refugee costs can be brought down to £2bn, less than half the £4.3bn spent last year, Mitchell says, 'the actual amount of non-refugee aid will fall to an all-time low'. There are now calls for Home Office spending on refugees to be subject to a cap so that true international aid spending can be protected. Aid can be delivered bilaterally, in an arrangement directly between countries, or multilaterally, through organisations funded by several countries and donors. The cuts come at the same time as many leading multilateral aid organisations, such as Gavi, the Vaccine Alliance and the Global Fund to Fight Aids, Tuberculosis and Malaria, are seeking renewed funding. The impact on those efforts of the trend for lower aid spending is as yet unclear. The US under Trump is pulling back from multilateral organisations including the World Health Organization and UNAids. Mitchell said the UK did, however, seem committed to multilateral efforts – it has committed to co-host fundraising efforts for the Global Fund this year, alongside South Africa. More globally, however, 'there are pressures to spend bilaterally and geopolitically', he says. 'And what I think is one of the really interesting things is that in the cold war, aid went up, precisely because countries were seeking to influence others. And so it's interesting that in what is effectively a rerun of the cold war, exactly the opposite is happening – at least [in] the west.' China does not seem to be stepping back from aid projects, although Dr Githinji Gitahi, chief executive of Amref Health Africa, says: 'China has been more focused on infrastructure. So if they can fill that gap, then you have to look for other partners for services like health workforce and commodities.' Starmer's announcement will not see UK spending stop suddenly, but it will take effect over the next two years. However, the US withdrawal has been abrupt and chaotic. American spending accounts for 50% of all development assistance to Africa and will be 'difficult to replace', says Gitahi. Speaking as hundreds of notices of termination started to arrive at HIV projects funded by the US in sub-Saharan Africa, Prof Linda-Gail Bekker of the Desmond Tutu Health Foundation in South Africa, said it would mean 'deep trouble' for the region. 'It lets the tiger out of the cage again [via an uncontrolled HIV epidemic], if you want to see it from a purely global threat point of view,' she says. And while there was the temptation to look for other funders around the world, 'there's real concern about where Europe and other countries are themselves', she says. 'We see no way out of this other than needing to see our own governments fill this gap.' That is likely to be hard for many countries struggling with debt and lower budgets. Gitahi says that even if African governments moved towards allocating 15% of their budgets to health spending – an African Union target – '15% of an elephant is very different from 15% of a chicken. And here we're talking about 15% of a chicken.' Starmer says the UK is entering an era where 'hard power' needed to take precedence, choosing defence spending over aid because 'the national security of our country must always come first'. Care International UK's chief executive, Helen McEachern, is among many describing that as a false choice. 'Not only does this decision do irreparable harm to his government's reputation, it ignores the vital role aid plays in making the UK and our world safer, healthier, and more sustainable for everyone,' she says. 'A true measure of our international standing is how we choose to treat those who are most vulnerable, exposed, and in danger. Make no mistake, this decision will endanger the lives of the world's most vulnerable. At a time of increasing international instability and attacks on fundamental human rights, the UK should be standing up for compassion and partnerships, not joining a race to the bottom.' Sign up to Global Dispatch Get a different world view with a roundup of the best news, features and pictures, curated by our global development team after newsletter promotion Grace* is in charge of implementing a US-funded climate resilience programme in Kenya's most arid areas, where the climate crisis has wreaked havoc over recent years. 'It's heartbreaking,' she said. 'The timing of aid cuts could not have been worse; we were just beginning to see some positive outcomes in the work on resilience building and sustainable agriculture that these communities need so badly. 'The programme was reaching half a million people – helping in animal husbandry and grazing planning – people who really need a sustainable approach to survive, for their livestock to survive.' Grace added: 'We were in the middle of construction work on 30 water use systems and we've had to have the sites closed. I'm worrying today if there are safety implications for children and animals at the sites. 'It is just unprecedented to lose all the work of years, to just have to stop work and leave communities stranded. It's beyond what we thought might be maybe the worst case scenario. 'At the moment we can't even reach them to explain what's going on.' Joachim Mumba is president of the International Federation of Social Workers in Zambia 'Two of my own siblings have been left unemployed due to the suspension of USAid-funded projects,' he said. 'My sister, the sole breadwinner for her family, had been supporting her daughter's education at the University of Zambia, where she is pursuing a degree in medicine. With her income now cut off, her daughter's academic future is uncertain. 'My younger brother has also lost his job. As a family, we had been pooling our resources to support our 78-year-old mother, who has been living with HIV for the past 20 years. 'Her survival has depended on the availability of antiretroviral therapy (ART), a programme largely supported by USAid funding. This disruption has not only ended our monthly contributions to her upkeep but has also raised concerns about the continued accessibility of life-sustaining medication. Thousands of lives here are at risk.' As of 2022, approximately 1.3 million people in Zambia were receiving ART, covering about 95% of the individuals living with HIV in the country (source: Among the most heartbreaking cases Mumba had heard of was a woman who killed herself after being laid off from a USAid-funded project. 'A close colleague told me of their distressing final interaction. They said, 'She actually sent me a text message in the morning, expressing how devastated she was … She wished the earth could just open wide and swallow her alive.' Later that day, news broke that she had taken her own life, unable to cope. 'Social media here has been flooded with similar reports of young people who have taken drastic actions following sudden job losses. For many, the loss of aid is more than just a policy decision. It is a matter of life and death.' Atong* is the manager of a safe house sheltering survivors of gender-based violence in Juba, capital of South Sudan. 'I'm very concerned,' she said. 'Except for one social worker who is staying as a volunteer, all our five staff members have had to stop working due to funding constraints. 'Since we opened in October 2022 thanks to money from USAid, we have hosted more than a hundred women and girls. A counsellor, trainers in livelihood and literacy, and two matrons have been helping women rebuild themselves and imagine a future – helping them find a job, go back to school or start a little business. 'Additional US funding had been pledged at the end of 2024, but now Mr Trump's orders jeopardises our future. 'Five women and five children are currently here. One survivor whose five-year-old daughter was raped, and who was threatened by the perpetrators when she tried to seek justice, was on a list of refugees accepted for resettlement to the US. But that is also off now, so she has to start from scratch. She broke down when we told her. 'I have been buying food for the house with my own money. But the pressure keeps mounting, the rent is due. Every time the landlord calls me, I get anxiety. This situation is taking a toll on my mental health. Where are these women going to go if the safe house collapses?' Overnight, the rug was yanked out from under us, slashing the services we can provide. The most drastic impact has been on malnourished children, since most supplies were provided by USAid. We have succeeded in finding enough ready-to-use therapeutic food (RUTF) to offer nine children a complete course of treatment, but we are down to our last container of F-75, a therapeutic milk for the sickest among the starving, too weak or little to consume the peanut-based supplements. Further stretching meagre supplies, 50,000 refugees fleeing war in Democratic Republic of the Congo streamed into Burundi last weekend. We have no idea how to feed the multitudes. We are dismayed that the UK and other governments appear to be following America's lead, falling dominoes nudging vulnerable families further into peril. Throughout history, hunger has been weaponised. In this epoch, when wielded by the world's wealthiest nation, it seems especially cruel. Food grown by American farmers is languishing in ports around the globe. The hospital I support in rural Burundi sits atop a steep hill. The land – donated to our organisation Village Health Works – is a dignified setting for medical care. Still, I worry about the paths people have to travel to reach it. The road is rocky, full of turns. Since there are limited vehicles in the region, many patients climb, requiring heroic effort from the sick. The bravest trekkers are the mothers, moving their own weight up the dirt road with babies on their backs. Their determination inspires our staff to work night and day, often to the point of exhaustion. At the end of their slog, the women used to arrive knowing their little ones would receive comprehensive treatment. Now, we face them with emptier Jennifer Furin * Names have been changed. Case studies as told to Florence Miettaux, Tracy McVeigh and Kaamil Ahmed
