Hypertension and Diabetes Grows Among India’s Poor Communities

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Health

A patient being checked for BP at Mann PHC. Credit: Rina Mukherji/IPS

A patient being checked for BP at Mann PHC. Credit: Rina Mukherji/IPS

MANN, India, Aug 26 2025 (IPS) – Generally thought to be diseases of the wealthier classes, non-communicable diseases (NCDs) like hypertension and diabetes are on the rise among India’s underprivileged working classes in semi-urban and rural sprawls.

Take the case of Mohan Ahire. A middle-aged gardener in Pune, Mohan never realized that the heaviness in his head was a symptom of hypertension. Last summer, a mid-morning visit to the market saw him fall unconscious on return. Upon regaining consciousness, his wife and sons discovered the paralysis on the right side of his body, leading doctors to diagnose it as a stroke.

Bahinabai Gaekwad, a 56-year-old sweeper in Mann village, was at work when she suddenly collapsed and died. Doctors from the Primary Health Centre (PHC) next door found that she had been suffering from undiagnosed hypertension for a long time. The ailment ultimately led to a fatal cardiac arrest.

The worst problem is that most patients from underprivileged sections are not aware of their health condition.

Praful Mahato, a migrant laborer from Balasore in Odisha, who is currently employed in a dhaba (roadside eatery) in Mann, a fast-industrializing rural outpost of Pune city, had been suffering from heaviness and dizzy spells for some time. But he attributed his symptons to long hours at work and resulting fatigue. A chance visit to a medical camp confirmed high blood pressure and diabetes. Since the last four months, medication has controlled his blood pressure and brought down his sugar level.

Jagdish Mondol, in his 50s, did not realize he had hypertension and diabetes until he needed to undergo a hernia operation at a government hospital in Bhadrak, Odisha. This was despite blurred vision and difficulty in walking. Thankfully, the operation got him to wake up to his health condition. Regular medication has now improved his blood pressure and sugar level.

Fortunately, some patients may seek help on their own. Lalita Parshuram Jadhav, a 40-year-old migrant construction worker from Yavatmal, is one such. “Since the last two years, I have been experiencing pain in my legs; it became quite acute over the past year,” she tells IPS. A medical check-up confirmed hypertension and high sugar levels.

India’s Hypertension and Diabetes Epidemic

The cases cited above exemplify the rising burden of India’s non-communicable disease (NCD) of Hypertension and Diabetes. Ranked among the top ten NCDs responsible for untimely deaths worldwide, these two diseases are interlinked. This means those with hypertension are also vulnerable to developing prediabetes and diabetes.

According to the World Health Organization (WHO), an estimated 1.28 billion adults in the 30-79 age group suffer from hypertension, with two-thirds of them living in low- and middle-income countries. Yet, only 21 percent of those affected have their hypertension under control, while around 46 percent of these remain unaware of their condition and remain undiagnosed and untreated.

Diabetes, notably, can be of two varieties. Type 1 Diabetes is a congenital condition, while Type 2 diabetes is a lifestyle disease that develops later in life. South Asians, Pacific Islanders, and Native Americans have a significantly higher risk of developing the disorder.

The International Diabetes Federation (IDF) recorded a dramatic increase in the number of people affected by Type 2 Diabetes globally since the 1990s, and since 2000, the rise has been dramatic. In India, there are an estimated 77 million people above the age of 18 years suffering from diabetes (type 2), while nearly 25 million are prediabetic (at a higher risk of developing diabetes in the future). Yet, more than 50 percent of these are unaware of their diabetic status.

In India, the prevalence of Diabetes rose from 7.1 percent in 2009 to 8.9 percent in 2019. Meanwhile, 25.2 million adults are estimated to have Impaired Glucose Tolerance (IGT), a prediabetic condition that is estimated to increase to 35.7 million in the year 2045. It is also estimated that approximately 43.9 million people suffering from diabetes remain undiagnosed and untreated in India, posing a major public health risk.

It is a matter of concern that most deaths from these diseases occur in the 30- to 70-year-old age group, posing a major economic loss.

In Mann, doctors at primary health centers (PHCs) are battling this scourge, with hypertension affecting around 28 percent of the population and 12 percent being diabetic. The scenario is similar to that at Mullaheera, in rural Haryana, located just outside the national capital region of Delhi.

Dr. Sona Deshmukh, from the People-to-People Foundation, which is collaborating with the Government of India on its Viksit Bharat @2047 initiative and the in-charge for the Pranaa Project, tells me, “Diabetes is common among the older population, but hypertension is rising among the youth.”

Dangers Posed by Hypertension and Diabetes

The problem with both Hypertension and Diabetes is socio-cultural, with most people viewing these diseases as benign. Yet, ignoring them can lead to paralytic strokes and ultimately, death.

Characterized by headaches, blurred vision, nosebleeds, buzzing in the ears, and chest pain,  uncontrolled and untreated hypertension can lead to—

  • chest pain (also termed angina);
  • heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen.
  • heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs; and
  • sudden death due to irregular heartbeat.

This is because excessive blood pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can result in the complications listed above, besides bursting or blocking arteries that supply blood and oxygen to the brain, causing a stroke. It can also cause kidney damage, resulting in kidney failure.

In the case of Diabetes, the body is unable to either produce or use insulin effectively. While individuals with Type I diabetes have a congenital condition wherein the insulin-producing cells in the pancreas are attacked and destroyed, patients with Type II diabetes—which is a preventable lifestyle-related disease—either do not produce enough insulin or are unable to use insulin effectively for the body’s needs. Uncontrolled diabetes can lead to blindness and organ failures that affect the kidneys, heart, and nerves, ultimately leading to diabetic strokes and death.

Reasons Behind the Spurt

So, what are the reasons behind the spurt? Government Medical Officers Dr. Mayadevi Gujar and Dr. Vaishali Patil say, “The transition of many rural outposts into semi-urban industrialized zones has brought in lifestyle changes. Locals, who once partook of healthy home-cooked millets or cereals, now eat cheap, oily snacks from wayside kiosks cooked in reused palm oil. With more disposable income, workers lean towards sugary soft drinks and fast food, making them prone to diabetes. Addictions like tobacco and alcohol are on the rise. Tobacco-chewing remains common to both men and women in rural India.”

Additionally, with climate change affecting agricultural incomes in rural India, the younger generation is stressed with employment issues. These make a potent recipe for hypertension and diabetes.

Dr. Sundeep Salvi, a noted specialist in cardiovascular diseases, who heads the Pulmocare Research and Education (PURE) Foundation and has chaired the respiratory group for the Global Burden of Disease Study, adds, “Unlike in the past, people eat and sleep late, watch late-night television, drink endless cups of tea and coffee, and work late hours. Skipping meals is common, with little time for exercise. Sleep deprivation is a fallout of this. Stress and inadequate sleep are a deadly combination, feeding hypertension and diabetes.”

Salvi calls for hydration and good nutrition to stave off hypertension and diabetes. “Excess tea and coffee are harmful. Caffeine-present in tea and coffee-is a diuretic; it prevents hydration. A dehydrated constitution results in hypertension and diabetes, which, in turn, cause heart disease, stroke, kidney diseases, and eventually, death.”

He also views air pollution as a major risk.

“By air pollution, I am referring to both indoor and outdoor pollution. In rural areas, the burning of crop waste causes outdoor pollution. But indoor pollution in rural homes and urban slums is 5–10 times greater than outdoor pollution. High levels of particulate matter contribute to 20 percent of the global burden of diabetes, as well as hypertension.

Diabetologist and Director of the Diabetes Unit at Pune’s KEM Hospital Prof. Chittaranjan Yajnik, who has been working on this issue for over two decades, has an interesting take on the matter based on his findings.

Yajnik sees a direct correlation between vulnerability to diabetes and poor intrauterine growth.

“Poor intrauterine growth reflects in poor organ growth, especially of the infra-diaphragmatic organs (liver, pancreas, kidneys, and legs), reducing their capacity to perform adequately in later years. Such individuals, when faced with overnutrition and calories later in life, end up with prediabetes and diabetes.”

Yajnik’s research found that two-thirds of prediabetic girls and a third of the prediabetic boys were underweight at birth.

“These findings are suggestive of a ‘dual teratogenesis’ concept, which envisages a combination of undernutrition and overnutrition over a life course due to rapid socio-economic and nutritional transition…” This means intrauterine programming of diabetes needs to be supported in growth-retarded babies since metabolic abnormalities develop very early in life.

Yajnik certainly has a point, since anemia in expectant mothers and low birthweight babies is a major problem all over India. The National Family Health Surveys conducted over the years by the Government have shown a persistently high prevalence of fetal growth restriction in Indian babies. This phenomenon is linked to low birth weight in newborns, which is as high as 18.24 percent, according to the latest data.

The Solution

Recently, the Ministry of Health and Family Welfare (MOHFW) of the Government of India has implemented several schemes nationwide at the primary health level, starting with nutrition, medical care, and immunization for pregnant mothers while ensuring institutional delivery. Offspring are also extended comprehensive help for the 4 D’s (defects at birth, diseases, deficiencies, and developmental delays), immunization, supplementary nutrition, and WASH interventions. These continue through adolescence to prepare a healthy population for reproductive age.

Meanwhile, weekly wellness sessions have been introduced all over India. Deshmukh adds, “Regular screenings for hypertension and diabetes are done every few months for early detection and follow-up. Counselling sessions encourage people to adopt healthier lifestyles, while Yoga is being popularized through events like the International Yoga Day.”

These initiatives, one hopes, will arrest the epidemic.

IPS UN Bureau Report

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Aid Funding Crisis Means Parliamentarians’ Visionary Leadership Even More Crucial

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Population

Dr. Alvaro Bermejo, Director General of the International Planned Parenthood Federation (IPPF) addresses the Let's Discuss the Future of Africa Together seminar that took place last week (August 21) on the sidelines of TICAD9 in Yokohama City, Japan. Credit: APDA

Dr. Alvaro Bermejo, Director General of the International Planned Parenthood Federation (IPPF) addresses the Let’s Discuss the Future of Africa Together seminar that took place last week (August 21) on the sidelines of TICAD9 in Yokohama City, Japan. Credit: APDA

YOKOHAMA CITY, Japan & JOHANNESBURG, South Africa, Aug 25 2025 (IPS) – As funding for sexual and reproductive health rights was on a “cliff edge,” parliamentarians now needed to play a “visionary” leadership role because “financing strong, resilient health systems for all their people rests with governments,” said Dr. Alvaro Bermejo, Director General of the International Planned Parenthood Federation (IPPF).

He was speaking at the Let’s Discuss the Future of Africa Together seminar that took place last week (August 21) on the sidelines of TICAD9 in Yokohama City, Japan.

The session was organized by the Asian Population and Development Association (APDA), in collaboration with the Forum of Arab Parliamentarians for Population and Development (FAPPD) and the African Parliamentary Forum on Population and Development (FPA).

He told parliamentarians that their role is most critical.

“Africa’s health faces a serious challenge: According to WHO’s latest analysis, health aid is projected to decline by up to 40% this year compared to just two years ago. This is not a gradual shift—it is a cliff edge,” Bermejo said. “You know as well as I do that lifesaving medicines are sitting in warehouses, health workers are losing jobs, clinics are closing, and millions are missing care.”

While this reality was outrageous, it needed to be adapted to.

“And in this crisis lies an opportunity—an opportunity to shake off the yoke of aid dependency and embrace a new era of sovereignty, self-reliance, and solidarity,” with a clear mission to protect the health and lives of women and vulnerable populations through delivering high-quality sexual and reproductive health services.

Parliamentarians engaged in debates during a policy dialogue seminar organised by the Asian Population and Development Association (APDA), in collaboration with the Forum of Arab Parliamentarians for Population and Development (FAPPD) and the African Parliamentary Forum on Population and Development (FPA). Credit: APDA

Parliamentarians engaged in debates during a policy dialogue seminar organized by the Asian Population and Development Association (APDA), in collaboration with the Forum of Arab Parliamentarians for Population and Development (FAPPD) and the African Parliamentary Forum on Population and Development (FPA). Credit: APDA

This seminar and another in the series, Policy Dialogue on the Africa-Japan Partnership for Population and Development, were both supported by the UN Population Fund (UNFPA) Arab States Regional Office (ASRO), the Japan Trust Fund (JTF) and IPPF.

During the discussions, a wide range of topics about population dynamics in Africa and Africa-Japan cooperation were discussed.

In his opening remarks, Ichiro Aisawa, a member of the House of Representatives of Japan, told the seminar it was necessary to take joint action across borders and generations.

“Youth holds the key to unlocking Africa’s future. By 2050, it is predicted that approximately 70 percent of Africa’s population will be under the age of 30. As African countries enter a demographic dividend period, the role played by parliamentarians in each country will be extremely important.

Aisawa said it was necessary to listen to the voices of the community in addressing issues related to youth empowerment, gender equality, and sexual and reproductive health (SRH).

Parliamentarians should take “concrete action through legislation and policies; it is essential to harnessing the potential of young people, directly linking them to social and economic growth, and creating a society in which no one is left behind.”

Yoko Kamikawa, Chairperson of Japan Parliamentarians for Population (JPFP), addresses a seminar for African and Asian parliamentarians on the sidelines of the TICAD9 in Yokohama City, Japan. Credit: APDA

Yoko Kamikawa, Chairperson of Japan Parliamentarians for Population (JPFP), addresses a seminar for African and Asian parliamentarians on the sidelines of the TICAD9 in Yokohama City, Japan. Credit: APDA

During the discussions, representatives from Africa gave examples of how Japan had supported their health initiatives, especially important in a climate of decreasing aid.

Maneno Zumura, an MP from Uganda, said what compounded the issues in her country and in Africa was “the changes in climate. The unpredicted climate has affected agricultural activities by 40 percent, especially in drought-prone areas of the country.” This had resulted in nearly a quarter (24 percent) of children experiencing malnutrition.

However, she noted that Japan had made considerable contributions to education and health.

“As we assess Uganda’s development and Japan’s impact, it’s clear that sustainable progress thrives on global solidarity and local governance. Key achievements include a 62 percent rise in women’s incomes through cooperatives, a 50 percent drop in maternal mortality in refugee settlements, and supporting the road infrastructure and education, illustrating how policy-driven interventions can break cycles of poverty and inequality.”

There were several specific projects she alluded to, including education experts from Japan who contributed to an improvement of the quality of primary education in districts of Wakiso, Mbale, and Arua through the Quality Improvement in Primary Education Project (2021-2023). They also trained 1,500 teachers in participatory teaching methods.

“The Government of Japan supported the vulnerable communities like refugees and host communities by strengthening the social services like health in refugee camps like Rhino Camp,” Zumura continued, including construction of a health center with antenatal facilities serving over 300,000 people in camps of Bidibidi and Rhino Camp. They also trained 200 health workers in the management of childhood illnesses and maternal health care.

Mwene Luhamba, MP, Zambia, said his country was looking forward to partnering with Japan in expanding One-Stop Reproductive Health Services, enhancing parliamentary engagement, and investing in youth programs.

Bermejo said part of the solution to the development issues is to confront constraints.

“Some countries in Africa do need global solidarity, but what Africa needs from the world, more than anything else, is fair terms. We must also confront the structural constraints. Debt service burdens are crowding out social investments. Let us seize this moment, not just to repair but to transform,” he said. “Sexual and reproductive health services save lives. They empower individuals, promote dignity, and drive national development.”

In her closing remarks, Yoko Kamikawa, Chairperson of Japan Parliamentarians for Population (JPFP), said that it was through dialogue across borders and sectors that “we build consensus, strengthen legal frameworks, and ensure that national strategies reflect the voices of all people and empower them—especially women and youth.”

IPS UN Bureau Report

 

Four Ways Asia Can Strengthen Regional Health Security Before the Next Pandemic

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Opinion

Regional cooperation can help countries respond more effectively to future pandemics. Credit: Asian Development Bank (ADB)

MANILA, Philippines, Aug 13 2025 (IPS) – In an interconnected world when infections can circle the globe in hours, cooperation in preparing for pandemics is essential. The COVID-19 pandemic highlighted just how vulnerable countries are when surveillance is fragmented, laboratory networks are underfunded and underequipped, and vaccines are not dispersed equitably.

To safeguard regional health security, several health interventions must be treated as regional public goods.

Regional public goods are services or assets that benefit multiple countries but cannot be provided by a single nation alone. They allow developing economies to cooperate on costs, expertise, and technology for greater development impact than they could achieve individually.

For example, efficient regional infrastructure and trade facilitation brings down transportation and trade costs and promotes freer movement of people and goods; delivering energy across borders improves access to sustainable energy; and financial agreements, such as the Chiang Mai Initiative Multilateralization, boost regional financial stability during crises.

Regional public goods fall into three broad categories: economic initiatives such as transport infrastructure, energy networks, and trade agreements like the Regional Comprehensive Economic Partnership; environmental efforts including river basin management, pollution control, and cross-border conservation programs; and social investments such as public health systems, regional education platforms, and collaborative research networks.

Countries in Asia and the Pacific already work together on trade, infrastructure, and climate action. Broadening areas of cooperation, however, can help countries meet their development goals and address increasingly complex health challenges, including emergencies.

This partnership is particularly important in the area of health emergency response.

A succession of human and animal infections including SARS, avian influenza, African swine fever and COVID-19 have shown just how quickly pathogens can go from a local problem to one that threatens regional and even global security. Countries can protect themselves through early alerts and early action via coordinated surveillance, data-sharing, and equitable vaccine access.

Responses to many recent outbreaks, including the COVID-19 pandemic, have been slow, fragmented, and unfair. Greater regional cooperation can mitigate the impacts of epidemics, especially for the most vulnerable, by pooling expertise, resources, and response capacities.

Health intersects with transport, trade, gender equality, education, and livelihoods. A healthy population underpins a resilient economy and supports social stability. Supporting each other to build systems that can prevent and respond to outbreaks makes sense for countries and the region.

To respond faster and smarter to the next pandemic, countries in Asia and the Pacific should focus on four high-impact areas regional integration and collective action:

Contact Tracing Networks

Early detection saves lives but only if data move faster than the disease. A regional contact tracing network, using interoperable digital tools and shared protocols, can help track outbreaks across borders.

By linking national systems through common standards and real-time data-sharing agreements, countries can monitor risks in high-risk areas, such as along borders and major transit corridors, and prevent spread.

Health Communications Coordination

Misinformation was a major problem during the COVID-19 pandemic, eroding public trust and weakening response efforts. A regional health communications framework, backed by multilingual messaging templates, rumor tracking systems, and coordinated press briefings, can ensure consistent, culturally relevant, and science-based public information across countries. Successes in reaching vulnerable populations and mobile communities can also be quickly shared.

Telemedicine for Cross-Border Care

Regional telemedicine platforms can connect healthcare providers across borders, especially in remote or small island states, ensuring continued access to care even when in-person services are disrupted. Joint investments in infrastructure, digital health standards, and clinician training can allow countries to offer virtual consultations, diagnostics, and even specialist referrals across the region.

Region-wide Public Health Funds

Collaborative procurement of vaccines, therapeutics and diagnostics have helped countries respond to disease outbreaks, and eradicate public health threats. Region-wide public health funds maintained by cooperating counties offer a means of improving timely access to life saving countermeasures.

Effectively preventing and preparing for pandemics requires countries to work in concert. These approaches can strengthen all types of health services and build resilience to all kinds of health threats. Now is the time to act decisively and secure a healthier, more prosperous future for all.

This article was originally published on the Asian Development Blog, and is based, in part, on research related to ADB’s 1st INSPIRE Health Forum: Inclusive, Sustainable, Prosperous and Resilient Health Systems in Asia and the Pacific. Ben Coghlan contributed to this blog post.

Dr. Eduardo P. Banzon is ADB Director, Health Practice Team, Human and Social Development Sectors Office, Sectors Group, who champions Universal Health Coverage and has long provided technical support to countries in Asia and the Pacific in their pursuit of this goal.

Dr. Michelle Apostol is a Health Officer for the Health Practice Team of ADB supporting the bank’s initiatives in strengthening health systems of member countries and advocating for the advancement of Universal Health Coverage (UHC).

Anne Cortez is a communications and knowledge management consultant with ADB. She brings over a decade of experience working with governments, think tanks, nonprofits, and international organizations on initiatives advancing health equity, climate action, and digital inclusion across Asia and the Pacific.

IPS UN Bureau

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Women in Sudan are Starving Faster than Men; Female-Headed Households Suffer

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In Sudan, women-led households are three times more likely to deal with serious food insecurity compared to male-led households. Credit: UN Women Sudan

UNITED NATIONS, Aug 12 2025 (IPS) – The food crisis in Sudan is starving more day by day, yet it is affecting women and girls at double the rate compared to men in the same areas. New findings from UN-Women reveal that female-headed households (FHHs) are three times more likely to be food insecure than ones led by men.

Women and girls make up half of the starving in Sudan, at 15.3 million of the 30.4 million people currently in need. In the midst of the current humanitarian crisis brought on by the Sudanese civil war, women are increasingly seen to be leading households in the absence of men due to death, disappearances or displacement amidst the civil war, making simply living in a FHH a statistical predictor of hunger.

“With conditions now at near famine thresholds in several regions in the country, it is not just a food crisis, but a gender emergency caused by a failure of gender-responsive action,” said Salvator Nkuruniza, the UN-Women representative for Sudan.

Famine Risks for Sudan’s Women

This famine has left only 1.9 percent of FFHs food secure, compared to 5.9 percent of male-headed households (MHHs) reporting food security. 45 percent of the FHHs reported poor food consumption which was nearly double the rate as compared to MHHs at 25.7 percent. Considering this, only one third of FHHs have an acceptable diet in comparison to half of MHHs. In these worsening conditions 73.7 percent of women nationally are not meeting the minimum dietary diversity, which is limiting nutrient intake and thus endangering maternal and child health.

Rates of poor food consumption have doubled in one year across FHHs, meaning a longer drawn conflict will see even worse numbers leading to the ultimate starvation of many. Nearly 15 percent of FHHs are living in conditions that meet or are near famine thresholds compared to only 7 percent of MHHs meeting the same threshold.

With all available funding, the World Food Programme (WFP) has scaled assistance to support nearly 4 million people per month, leaving an additional 26 million people still in need of support. As one representative from the UN Office of the Coordination of Humanitarian Affairs (OCHA) told IPS, under these circumstances WFP has had to make tough calls, either shrinking assistance packages or reducing the amount of people who receive assistance. There have been cases where they have been forced to cut off all assistance in general.

Within Sudan’s civil society, women-led organizations (WLO) are playing a central role in delivering vital meals to affected groups across Sudan. Nkurunziza told IPS that “WLOS are the backbone of response in many areas,” who can access areas which the international system cannot reach. WLOs in West Kordofan are solarizing clinics, running nutrition outreach, managing mobile maternal health care, and operating informal shelters. In North Kordofan, WLOs. are running protection hotlines, distributing food, and helping displaced families find safety. Many times they are providing these services without institutional funding.

UN Women has been supporting 45 WLOs with institutional support, funding and technical assistance, which has allowed these organizations to operate across sixteen states. However, underfunding still remains a critical issue for WLOs. Nkurunziza explained how due to funding deficits, one WLO that operates across eight states was forced to shut down thirty-five of its sixty food kitchens. WLOs must also deal with serious logistical and digital constrains, making it nearly impossible to have any form of coordination meetings. Sudan is also facing the world’s largest displacement crisis, making a shrinking of operations among deteriorating consumption rates detrimental to attempts to elevate food security.

Aid Delivery Challenges

Amidst funding shortfalls, supply chains have struggled reaching critical locations due to Sudan’s size, lack of infrastructure, and weather difficulties. WFP shared that Sudan is “roughly the size of western Europe”, and as such they and other humanitarian actors are having to transport humanitarian items over 2500 kilometers across deserts and challenging terrain. They added that road infrastructure in remote areas such as Darfur and Kordofan has further increased the difficulty. The rainy season between April and October has also added further complications, which has made many roads completely flooded or impassable.

WFP said that the conflict has not only affected supply chains, but trade routes themselves. Among the besieged cities of El Fasher and Kadulgi, supplies remain limited and far and few. WFP is “extremely concerned about the catastrophic situation, especially in El Fasher and Kadulgi and urgently [needed] guarantees of safe passage to get supplies in – while we continue supporting with digital cash transfer”. This comes amidst not being able to deliver food and aid supplies by road.

Gender Disparities and Solutions

Nkurunziza told IPS that even before the conflict, women and girls “faced challenges in accessing their rights due to cultural norms and traditional practices”, adding that this conflict has only widened these gaps.

Food access is only one example of how gender inequality manifests during this crisis. Nkurunziza noted that food queues are often dominated by men compared to women from FHHs. He added that women have been “largely left out” of decision-making spaces, therefore their specific needs are “frequently overlooked”.

The search for food has caused an increase in harmful coping mechanisms like child marriage, sexual exploitation, female genital mutilation, and child labor. The nature of these harmful instances come from unchecked sexual exploitation and abuse due to the lack of law enforcement and government in many areas. Since April 2023, 1,138 cases of rape have been recorded, including 193 children. This number is expected to be even higher, as social and security fears may be preventing accurate reporting of gender-based violence crimes.

“The conflict has magnified every existing inequality,” Nkurunziza said, adding that this created the need for responsive action, moving beyond simple rhetoric.

In their report, UN Women outlined several measures that needed to be adopted in order to diminish famine conditions among women, including prioritizing food distribution and assistance planning to FHHs and establishing localized distribution sites, thus reducing movement-related risks for women. They also recommended increased representation in local aid committees and decision-making spaces by at least 40 percent. They called for increasing investment and funding to WLO’s, which are currently receiving less than 2 percent of humanitarian aid funds.

Despite these challenges, Nkurunziza said that WLOs are still working to feed families. “They are not waiting for permission — they are responding. The question is whether the system will finally recognize them as equal partners or continue to leave them behind.”

IPS UN Bureau Report



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‘After Decades of Making Huge Profits, Companies Shouldn’t Be Allowed to Leave Behind a Toxic Legacy’

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Jul 29 2025 (IPS) –  
CIVICUS speaks with Matthew Renshaw, a partner at a UK law firm that represents Nigerian communities taking legal action against Shell over environmental damage caused by its operations in the Niger Delta.

Matthew Renshaw

Two Nigerian communities, Bille and Ogale, are suing Shell in the UK over decades of oil spills in the Niger Delta that have devastated their land, water and way of life. The High Court has ruled that Shell and its former Nigerian subsidiary can be held liable for ongoing environmental damage, even if caused by oil theft or sabotage, and regardless of how long ago the spills occurred. The decision builds on a 2021 Supreme Court ruling that allowed UK-based parent companies to be sued for harm abroad. A full trial is set for March 2027.

How has oil pollution affected these communities?

Each of the three communities we represent in the Niger Delta have been affected by Shell’s operations in different ways.

The Bodo community endured two major oil spills from Shell pipelines in 2008 that released over half a million barrels of oil, causing the largest devastation of mangrove habitat in history. Families who once depended on fishing can no longer provide for themselves. Even swimming in the waterways is dangerous due to oil contamination. Despite bringing the case before UK courts in 2011, the community is still demanding a proper cleanup that they say has never materialised.

As for the Bille and Ogale communities, they brought their cases against Shell in the UK in 2015. The Ogale community depends primarily on farming and fishing, but since the 1980s, Shell has recorded around 100 spills in and around the area that have resulted in serious contamination of the drinking water. The United Nations conducted tests in 2011 and declared a public health emergency, but very little was done in response. Shell briefly provided safe water to residents, but that ended years ago. With no alternative sources available, many people have been forced to use visibly polluted water to drink and bathe their children.

The Bille community lives on islands in a riverine area where residents depend heavily on fishing and harvesting shellfish. A major pipeline runs directly through the community, very close to where people live. Between 2011 and 2013, multiple oil spills from Shell destroyed mangrove habitats. As with the Bodo community, fishing has become impossible for many people, forcing some to abandon their homes and communities entirely.

Why sue in the UK rather than Nigeria?

The decision to sue Shell in the UK came from our clients. While Shell operates in Nigeria through a local subsidiary, the parent company is based in the UK and has profited immensely from its Niger Delta operations, so our clients view it as equally responsible for the pollution in their communities.

They also believe they can’t get justice in Nigeria. The Nigerian legal system is notoriously slow: cases can take decades to reach judgement due to automatic rights of appeal. Many people won’t live to see justice. Bringing this type of case before Nigerian courts is also prohibitively expensive, because it requires extensive expert evidence that’s inaccessible to most affected communities.

In contrast, UK funding mechanisms make it far more feasible for our clients to pursue justice. They also trust they’ll receive a fairer hearing in London. This approach has already shown results: in the Bodo case, Shell finally brought in international experts to attempt cleanup. International litigation generates meaningful outcomes that wouldn’t happen otherwise.

Even when Shell argued that the case should be heard in Nigeria, in 2021 the UK Supreme Court ruled that because Shell PLC may share responsibility with its subsidiary, the case could proceed in London.

How is Shell defending itself?

Shell claims that most Niger Delta pollution stems from oil theft by local criminals, commonly known as ‘bunkering’. According to Shell, these criminals steal oil from pipelines to sell directly or refine into fuel. The company insists its operations are clean and criminals are to blame, arguing it’s doing its best to stop theft and therefore shouldn’t be held responsible.

This defence is fundamentally flawed. While oil theft is certainly a significant problem in Nigeria, Shell’s claims are overstated. Numerous spills have nothing to do with theft. They’re caused simply by poorly maintained infrastructure and decades-old pipelines that are not fit for purpose. This stands in stark contrast to other countries where maintenance is taken far more seriously.

Even accepting Shell’s argument, our clients contend that Shell should have taken reasonable precautions to prevent foreseeable theft. In other countries, pipelines are buried, fitted with detection systems and monitored closely to detect intrusion attempts or spills. Our clients contend that Shell has failed to implement these basic measures in the Niger Delta.

What did the recent court ruling say, and what do you hope to achieve?

The High Court sided with our position, ruling that if Shell failed to take reasonable steps to prevent foreseeable harm, it can be liable for pollution caused by bunkering. Significantly, the court also rejected Shell’s claims that it couldn’t be held liable for spills older than five years, ruling that if a spill has still not been cleaned up – even if it happened decades ago – the company can still be held accountable.

This ruling has far-reaching implications. It’s particularly significant for the Ogale case where pollution dates back to the 1980s, and it opens the door for many other Niger Delta communities affected by legacy spills dating to the 1970s or earlier. Beyond Nigeria, the ruling sends a warning to multinational companies attempting to divest from polluting operations without accepting responsibility for the damage left behind.

Our clients seek three main outcomes from the 2027 trial: proper cleanup and environmental remediation of their polluted lands, emergency provisions such as access to clean drinking water and compensation for lost livelihoods and damaged property.

A pressing concern is Shell’s recent divestment from its onshore operations in Nigeria. The company has sold its assets to a consortium and is attempting to walk away from decades of pollution. While the communities we represent have at least secured court proceedings, many others have been left behind with no cleanup and no accountability.

We’re determined to prevent Shell and other multinational companies from abandoning polluted sites without taking responsibility. Success in holding Shell accountable, including for decades-old spills, could establish crucial legal precedents. Legally, it would confirm that companies remain responsible for long-term environmental damage. Morally, it’s about basic fairness: after decades of extracting resources and making huge profits, companies shouldn’t be allowed to leave behind a toxic legacy.

While our case won’t create internationally binding precedents, it could significantly influence how similar claims are litigated in other countries, particularly in common law jurisdictions.

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SEE ALSO
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Chiquita verdict offers hope for corporate accountability CIVICUS Lens 29.Jul.2024
Peru’s oil spill raises corporate accountability questions CIVICUS Lens 01.Apr.2022

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Sweet Hope to End Bitter Pills for Multidrug-Resistant Tuberculosis

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Active Citizens, Africa, Civil Society, Development & Aid, Editors’ Choice, Featured, Headlines, Health, Human Rights, Humanitarian Emergencies, Sustainable Development Goals, TerraViva United Nations, Youth

Health

Rallying call to end TB by 2030. Credit: Busani Bafana/IPS

BULAWAYO, Jul 15 2025 (IPS) – Every day, Yondela Kolweni has to hold down her son, who screams and fights when it is time for his daily life-saving TB tablets—a painful reminder of her battle with the world’s top infectious killer disease.

“It is a fight I win feeling awful about what I have to do,” says Kolweni (30), a Cape Town resident and a TB survivor. “The tablets are bitter, and he spits them out most of the time, and that reminds me of the time I had to take the same pills.”

Kolweni’s five-year-old son is battling Multidrug Resistant TB (MDR TB), a vicious form of TB that is rising among children globally.

The global burden of MDR-TB among children and adolescents has increased from 1990 to 2019, particularly in regions with lower social and economic development levels, according to a recent study. In addition, the top three highest incidence rates of MDR TB in 2019 were recorded in Southern sub-Saharan Africa, Eastern Europe, and South Asia, while the top three highest rates of deaths in the same period were recorded in Southern, Central, and Eastern sub-Saharan Africa.

South Africa is one of 30 countries that account for 80 percent of all TB cases in the world and has the most cases of drug-resistant TB.

A Bitter Pill to Swallow

Kolweni’s son was diagnosed with MDR-TB five years ago, having tested positive for TB which has affected his grandmother and his mother. He was immediately on treatment, a drug cocktail that included moxifloxacin—a pill not for the yellow-livered.

“There were two medications he had to take, and there was one specifically, the yellow one, that he did not like, and with the color he knew what it was,” Kolweni told IPS in an interview, explaining a daily battle to get her son to take his meds.

It was down to a fight. She crushed the tablets, mixed them with a bit of water, and fed them through a syringe.

“We would sometimes hold him or wrap a towel around him so that we could feed him the medication, but he would still spit it out, which meant he was not taking the dosage he was meant to take,” said Kolweni. “We then came up with the idea to put his tablets in his yogurt, but that technique did not work because, being a smart kid, he took the bait but would soon spit out the medication.”

Moxifloxacin, an exceptionally bitter medicine, is one of the key drugs in the new all-oral treatment for multidrug-resistant tuberculosis (MDR TB). The treatment is a combination of the drugs Bedaquiline, Pretomanid, Linezolid and Moxifloxacin, known as BPaLM. The BPaLM regimen is specially formulated for children but is a bitter pill to swallow.

Sweet Medicine

But there is sweet hope. A new study, by Stellenbosch University and the TB Alliance, found that sweet, bitter-masked versions of Moxifloxacin significantly improve kids’ willingness to take the drug—easing the burden on parents and boosting treatment adherence.

Two formulations of moxifloxacin have been identified by children as tasting better than new generic versions of products currently on the market.

The results from the ChilPref ML study—a Unitaid-funded effort sponsored and led by Stellenbosch University in collaboration with TB Alliance—will help improve MDR TB treatment and adherence in children.

Dr. Graeme Hoddinott, of Stellenbosch University and the principal investigator of the study, notes that children cannot be treated in a humane manner for drug-resistant TB if the medicines taste so terrible that children refuse them or must be forced to take them.

Children diagnosed with drug-sensitive TB have good outcomes even within the four months because there is usually one tablet given, and there is a child-friendly formulation that dissolves easily to be given on a spoon or in a syringe, Hoddinott said. However, for drug-resistant TB, the situation is complicated. Most drugs for MDR TB are no longer used because of their toxicity and have been replaced by new drugs.

MDR-TB drugs are not child-friendly, Hoddinott admits. The active ingredient that kills TB in Moxifloxacin makes the pills incredibly bad tasting for children who have to take the medication daily for between six and nine months in cases of MDR TB.

“These drugs are incredibly bad tasting; they are genuinely awful to a point where adults who have been on extended TB treatment have been unable to administer the same drugs to their children because the smell evokes the time when they were sick,” Hoddinott told IPS. “It is a trauma to administer such bad-tasting drugs to a child, both for the parent and the child, particularly for the young children.”

The ChilPref study recruited just under 100 healthy children, ages 5–17, from two diverse settings in South Africa. The children evaluated flavor blends using a ‘swish and spit’ taste panel—tasting the medicine, which was dissolved in water, and then spitting it out without ingesting any of it.

Each child participant ranked the flavor blends among the three from each manufacturer and also rated the taste, smell and other characteristics of each. For moxifloxacin, there was a clear, strong preference for the new flavor blends (“bitter masker” and orange for Macleods, and strawberry and raspberry and tutti frutti for Micro Labs) over the existing commercially available flavors for both manufacturers. For Linezolid, there was no preference between the flavor blends.

“Ensuring children have access to effective and palatable TB treatments is a crucial step in improving adherence and treatment outcomes,” said Koteswara Rao Inabathina, one of the study’s authors and CMC Project Manager at TB Alliance.

“Through close collaboration with manufacturers, we have addressed critical unmet needs by developing practical solutions that make available and effective drug-resistant TB treatments not only accessible but also palatable and acceptable for children.”

The results of the ChilPref study showed that children preferred two new flavor blends of moxifloxacin, produced by Macleods Pharmaceuticals, India, and Micro Labs Pharmaceuticals, India. The results were communicated to the manufacturers, who are already updating their products.

“We are not surprised that a lot of kids did not like any of the tastings because we knew that they were horrible taste-wise, but we got a very clear signal for both manufacturers that the flavor blends we recommended were more preferred,” Hoddinott said. “We changed which flavor was going to market with relatively simple research.”

Dr. Cherise Scott, Senior Technical Manager at Unitaid, said the easier it was for children to take their medicines regularly, the more likely they were to complete their treatment successfully.

“We will not allow children to be neglected in global health responses simply because their needs are more complex.”

A Promising Treatment for MDR TB

As multi-drug-resistant TB transmission increases among children and adolescents, the development of new treatments is imperative, Hoddinott explained.

Moxifloxacin may also be increasingly used in the future for the treatment of drug-susceptible TB, which affects an estimated 1.2 million children globally each year.

Drug-resistant TB, has previously been one of the most difficult diseases to manage because of limited child-friendly treatment options, but scientists have made strides in developing new treatments for children, explains Dr. Anthony Garcia-Prats, one of the study authors and an associate professor at the University of Wisconsin-Madison.

“Now we are making sure that these medicines are appropriate for children, starting with an aspect that children and parents say is critical: taste,” Garcia-Prats said in a statement.

The new treatment is given when TB is either resistant to rifampicin, a critical first-line drug, or rifampicin and isoniazid, another first-line drug combination. These resistant strains are collectively referred to as RR/MDR-TB.

Annually there are an estimated 32,000 new cases of RR/MDR-TB among children 14 years and under—a population that is extremely sensitive to the taste of medicine, according to researchers.

This discovery could help improve adherence to TB medication and move a step closer towards the United Nations Sustainable Development Goal 3 to end TB by 2030.

“It is not a silver bullet,” Hoddinott cautions. “It does not solve everything, as people affected by TB still face many other challenges, and even the preferred flavor blends still do not taste nice. But, as part of the overall fight against TB in children, it’s an important step.”

Kolweni welcomes the development of masked TB medication.

“My experience with TB medication was not nice, and for children it is worse, and I think flavored tablets would make it easy for children to take, like  Gummies,” she said. “Every child loves flavors; even a suspension would be nice. My son would love it, and I will have no trouble getting him to take his medicine.”

Note: This article is brought to you by IPS Noram, in collaboration with INPS Japan and Soka Gakkai International, in consultative status with the UN’s Economic and Social Council (ECOSOC).

IPS UN Bureau Report

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