Sweet Hope to End Bitter Pills for Multidrug-Resistant Tuberculosis

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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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The Risks Artificial Intelligence Pose for the Global South

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Artificial Intelligence

UN Secretary General António Guterres addresses the session “Strengthening multilateralism, economic - financial affairs and artificial intelligence” on July 6 at the 17th summit of BRICS in Rio de Janeiro. For the first time ever, artificial intelligence was a major topic of concern at the BRICS summit. Credit: UN Photo/Ana Carolina Fernandes

UN Secretary General António Guterres addresses the session “Strengthening multilateralism, economic – financial affairs and artificial intelligence” on July 6 at the 17th summit of BRICS in Rio de Janeiro. For the first time ever, artificial intelligence was a major topic of concern at the BRICS summit. Credit: UN Photo/Ana Carolina Fernandes

UNITED NATIONS, Jul 14 2025 (IPS) – Artificial intelligence (AI) is rapidly developing and leaving its mark across the globe. Yet the implementation of AI risks widening the gap between the Global North and South.

It is projected that the AI market’s global revenue will increase by 19.6 percent each year. By 2030, AI could contribute USD 15.7 trillion to the global economy. However, the increases to nations’ GDP will be unequally dispersed, with North America and China experiencing the most gains while the Global South gains far less.

The risks of AI to the Global South

Due to smaller capacities to fund research, development and implementation, fewer countries in the Global South are adopting AI technology. Access to affordable AI compute to train AI models is one of the AI field’s greatest barriers to entry in the Global South, according to the 2024 UN report, “Governing AI for Humanity.”

Further, AI is designed to create profitable market extraction that does not benefit the global majority, according to Vilas Dhar, President and Trustee of the Patrick J. McGovern Foundation. As countries in the Global North are AI’s primary investors, it is being developed to address their needs.

“The result is a quiet erosion of political and economic autonomy,” he said. “Without deliberate intervention, AI risks becoming a mechanism for reinforcing historical patterns of exploitation through technical means. It also risks losing the incredible value of diverse, globally minded inputs into designing our collective AI future.”

Across the world, people risk losing their jobs to AI, but many countries in the Global South are reliant on labor intensive industries, and AI poses a greater threat to increasing unemployment and poverty. Particularly children, women, youths, people with disabilities, older workers, creatives and people with jobs susceptible to automation are at risk.

According to Daron Acemoglu, professor at the Massachusetts Institute of Technology, labor-replacing AI poses a greater threat to workers in the developing world, as capital-intensive technology may not be useful in these nations where oftentimes capital is scarce and labor is abundant and cheap. Technology that prioritizes labor-intensive production is better suited to their comparative advantage.

“Because advanced economies have no reason to invest in such labor-intensive technologies, the trajectory of technological change will increasingly disfavor poor countries,” he said.

If these trends continue, these nations will experience increased unemployment and fall behind in the deployment of capital-intensive AI, due to limited financial resources and digital skill sets. More AI policies and guidelines, as well as education on data privacy and algorithmic bias, could assist in reducing this inequality.

Evidently, AI threatens to widen the gap between the Global North and South, as AI capacities are consolidated within a small group of institutions and regions. In Dhar’s view, AI will need to be designed to serve people and problems rather than be focused on profit maximization.

“If left unaddressed, this imbalance will cement a way of thinking about the world that mirrors the development of the Internet or social media – a process we do not want to replicate,” Dhar said.

Opportunities of the new technology

But the development of AI also poses opportunities for the Global South.

AI could design context-specific systems for local areas in the Global South that are not just based on the Global North, according to Dhar. “It can unlock new models of inclusion and resilience,” he said.

For example, AI could aid farmers in decision-making by informing them of weather and drought predictions using geospatial intelligence, as well as of marketing price information. AI could also help train farmers and other producers. It can also be used to improve education and healthcare in nations where these are major issues harming their populations and stunting development.

Acemoglu said that AI should be developed to complement rather than replace human labor for these benefits to become possible. “That will require forward-looking leadership on the part of policymakers,” he said.

AI in conflict

AI is also starting to make an appearance in conflict. In Ukraine, autonomous drones are being used, which are capable of tracking and engaging enemies, as well as BAD.2 model robot dogs, which are ground drones that can survey areas for enemies. Autonomous machine guns are also used, in which AI helps spot and target enemies.

The use of AI in conflict poses an ethical dilemma. AI could protect human lives on one side of the conflict but pose a great threat to the lives on the other end of the battlefield. This also raises the question of whether AI should be given the power to engage in harm.

But perhaps the use of AI can reduce the number of people engaging in conflicts harming developing countries and move these people to other sectors where they can realize more potential and aid their country’s economic development.

What international frameworks should do

Clear international frameworks must be established to prevent a rise in inequality and a greater gap between the Global North and South.

For the first time ever, AI was a major topic of discussion at the 17th BRICS summit, which serves as a coordination forum for nations from the Global South, in Rio de Janeiro. BRICS member countries signed the Leaders’ Declaration on Global Governance of Artificial Intelligence, which presents guidelines to ensure AI is developed and used responsibly to advance sustainability and inclusive growth.

The declaration called on members of the UN to promote including emerging markets and developing countries (EMDCs) and the Global South in decision-making regarding AI.

“New technologies must operate under a governance model that is fair, inclusive, and equitable. The development of AI must not become a privilege for a handful of countries, nor a tool of manipulation in the hands of millionaires,” Brazilian president Luiz Inácio Lula da Silva said at the summit.

However, the UN report “Governing AI for Humanity” found that 118 countries, most of which are in the Global South, were not part of a sample of non-UN AI governance initiatives, while seven countries, all of which are in the Global North, were included in all initiatives.

According to Dhar, global governance must create a more equitable distribution of power that entails sharing ownership and embedding the Global South at every level of institutions, agreements and investments, rather than simply for consultation. These nations must also be aided in building capacity, sharing infrastructure, scientific discovery and participation in creating global frameworks, he said.

In his remarks at the BRICS summit, UN Secretary-General António Guterres expressed his concern over the weaponization of AI and stressed the importance of AI governance that is focused on equity. He said in order for this to be done, the current “multipolar world” must be addressed.

“We cannot govern AI effectively—and fairly—without confronting deeper, structural imbalances in our global system,” Guterres said.

Dhar emphasized that the inclusion of every person in the conversation on AI is crucial to creating legitimate global technological governance.

The future of AI is being negotiated with immediacy and urgency,” Dhar said. “Whether it becomes a force for collective progress or a new vector for inequality depends on who is empowered to shape it.”

IPS UN Bureau Report

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Conflict, Climate Change Push Migrants in Yemen to Return to Their Home Countries

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Humanitarian Emergencies

People in Yemen impacted by war and climate shocks receive aid from the IOM. Photo credit: Majed Mohammed/IOM Yemen

People in Yemen impacted by war and climate shocks receive aid from the IOM. Photo credit: Majed Mohammed/IOM Yemen

UNITED NATIONS, Jul 13 2025 (IPS) – Yemen’s humanitarian crisis, driven by conflict, economic collapse and climate shocks, leaves migrants desperate to return to their home countries.

In March 2025, the Global Data Institute Displacement Tracking Matrix recorded that 1,234 non-Yemeni migrants left the country.

Once a critical transit and destination point, Yemen is unable to support incoming asylum seekers. Yemenis are struggling to survive amidst a decade-long conflict and worsening climate change impacts. Over 4.8 million people are internally displaced, and 20 million rely on aid.

Most migrants come from Ethiopia and Somalia, searching for safety or work in the Gulf countries. However, many become stranded in Yemen due to the harsh conditions and abuse.

The International Organization for Migration (IOM) found that in 2024, around 60,900 migrants arrived in Yemen with no means to survive. Subsequently, they are exposed to severe protection risks, including physical and sexual violence, exploitation, abduction, detention, and debt bondage.

“With limited humanitarian resources and few service providers on the ground, migrants often suffer from hunger, untreated medical conditions, and lack of shelter. Many are stranded without access to even the most basic services,” said the IOM to IPS.

“Meanwhile, public hostility toward migrants has increased, as they are increasingly viewed as competing with vulnerable Yemeni populations for scarce assistance. The ongoing conflict in Yemen further compounds these vulnerabilities, with migrants caught in airstrikes, exposed to explosive ordnance, and lacking access to safety.”

Women and girls are the most vulnerable group of migrants traveling through Yemen. They are disproportionately threatened with gender-based and sexual abuse.

“I’ve been beaten, detained, and exploited in Yemen,” said a 24-year-old Ethiopian woman to IOM. “Most nights, I went hungry. After everything that happened to me, I am happy to go back to my home and family.”

Severe climate impacts also make it increasingly difficult for both migrants and Yemenis to access food and water. Around 17.1 million Yemenis are struggling with food insecurity, and climate-related issues are only exacerbating this crisis.

The June 2025 Migration, Environment, and Climate Change (MECC) Country Report on Yemen by the IOM says that Yemen is the 12th most water-scarce country in the world. This significantly influences food insecurity, as rising temperatures caused by climate change create unpredictable rainfall.

In some areas, severe droughts are turning fertile farmland into arid deserts, forcing farmers to plant new crops or move in search of better conditions. Meanwhile, in other communities, heavy rain is sparking extreme flooding. Impacted areas are decimated by soil erosion and disease from contaminated water.

“Areas that used to experience heavy rainfall have now suffered from drought, and farmers have to adapt to this drought by either planting drought-resistant crops, changing their livelihoods, or migrating to another location. And some areas used to suffer from drought but now experience heavy rainfall, where the intensity of rainfall has led to the emergence of new diseases brought by floods,” said an official in the General Authority for Environmental Protection responsible for planning and information to the IOM.

Together, brutal conflict and a lack of access to vital necessities significantly limit migrants’ ability to return to their home countries. The IOM reported that in 2020, around 18,200 people risked their lives traveling by sea. Overcrowded vessels traversing rough waters often capsize, killing dozens on board.

For others, their journey back home leads them through heavily war-inflicted areas. Without proper assistance, migrants are left to navigate through dangerous frontlines, risking death from armed violence and landmines.

However, programs like the IOM’s Voluntary Humanitarian Return (VHR) aim to facilitate migrants’ safe return home. VHR is one of the only solutions for stranded migrants to voluntarily return in a safe and dignified manner.

So far, the IOM has helped 66 migrants safely return this year. This is a significant drop compared to the 5,200 individuals returned in 2024.

“IOM provides lifesaving protection and health service through Migrant Response Points (MRPs) in Aden, Sanaa and Marib and Community-based Care centers in Aden and Sanaa, as well as through mobile teams along the migratory routes funded by ECHO and UK FCDO,” said the IOM to IPS. “Since 2015, IOM has been facilitating Voluntary Humanitarian Return (VHR) as the only viable solution for stranded migrants who wish to return home voluntarily, safely, and with dignity.”

The IOM is backed by numerous groups such as the European Union, the King Salman Humanitarian Aid and Relief Centre (KSrelief), the US State Department’s Bureau of Population, Refugees and Migration, and the governments of Germany, France, Norway, and Finland. Unfortunately, despite widespread support for the program, more donations are urgently needed. The IOM is struggling to help migrants due to significant funding cuts.

“As migration flows continue to surge, the demand for safe and dignified return options for migrants has reached critical levels,” said Matt Huber, IOM’s former Chief of Mission in Yemen. “Without immediate funding support, the continuity of this vital programme is at risk, leaving thousands of vulnerable migrants stranded in precarious conditions with many experiencing serious protection violations.”

IPS UN Bureau Report

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HIV/AIDS Funding Crisis Risks Reversing Decades of Global Progress

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Health

About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report was Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report was Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

UNITED NATIONS, Jul 10 2025 (IPS) – UNAIDS called the funding crisis a ticking time bomb, saying the impact of the US cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) could result in 4 million unnecessary AIDS-related deaths by 2029.

A historic withdrawal of global HIV/AIDS funding threatens to derail decades of hard-won progress in the fight against AIDS, according to UNAIDS’ annual report, entitled Aids, Crisis and the Power to Transform. This funding shortage – caused by sudden and massive cuts from international donors – is already dismantling frontline services, disrupting lifesaving treatments for millions and endangering countless lives in the world’s most vulnerable communities.

“This is not just a funding gap—it’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima.

Despite major strides in 2024, including a decrease in new HIV infections by 40 percent and a decrease in AIDS-related deaths by 56% since 2010, the onset of restricted international assistance, which makes up 80 percent of prevention in low- and middle-income countries, could have disastrous effects. The report, mostly researched at the end of 2024, concluded that the end of AIDS as a public health threat by 2030 was in sight.

However, in early 2025 the United States government announced “shifting foreign assistance strategies,” causing them to withdraw aid from organizations like the President’s Emergency Plan for AIDS Relief (PEPFAR), which had earlier promised 4.3 billion USD in 2025. PEPFAR is one of the primary HIV testing and treatment services in countries most affected. Such a drastic decision could have ripple effects, including pushing other major donor countries to revoke their aid. The report projected that if international funding permanently disappears, they expect an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029.

At a Press Briefing, Assistant Secretary-General for UNAIDS Angeli Achrekar noted the importance of PEPFAR since its inception in 2003, calling it one of the most successful public health endeavors. She expressed hope that as the US lessens its support, other organizations and countries are able to take up the global promise of ending AIDS without eroding the gains already made.

Achrekar noted “acute shifts” in a weakening of commitment from countries less directly affected by HIV/AIDS since the US has pulled funding.

UNAIDS also reports a rising number of countries criminalizing populations most at risk of HIV – raising stigma and worsening gender-based violence and non-consensual sex, two of the highest HIV risk-enhancing behaviors. The report showed the primary groups who lacked care were child HIV infections and young women, which is likely related to government campaigns  “attacking HIV-related human rights, including for public health, with girls, women and people from key populations.”

These punitive laws include criminalization or prosecution based on general criminal laws of HIV exposure, criminalization of sex work, transgender people and same-sex sexual activity and possession of small amounts of drugs. These laws have been on the rise for the past few years, and in conjunction with limited funding, the results for HIV/AIDS-positive patients could be fatal.

Recently, scientific breakthroughs have been made regarding long-acting medicine to prevent HIV infection. Health workers have seen tremendous success, both with new technologies like annual injections and the potential for more growth in the form of monthly preventative tablets and in old prevention techniques like condom procurement and distribution and access to clean, safe needles for drug users. However, due to various global conflicts and wars, supply chains have been disrupted, often harming countries not in the thick of the altercation but reliant on products like PrEP, an HIV prevention medication.

Although many countries most afflicted with the AIDS crisis have stepped up, promising more national funding for the issue, and many community networks have doubled down on their efforts, the disruption of supply chains and the lack of international frontline health workers cannot be solved overnight. To entirely restructure how healthcare is provided takes time – something those with HIV do not always have.

Areas like sub-Saharan Africa, which in 2024 housed half of the 9.2 million people not receiving HIV treatment, have been particularly affected by the recent changes. The majority of child infections still occur there, and combinations of “debt distress, slow economic growth and underperforming tax systems” provide countries in sub-Saharan Africa with limited fiscal room to increase domestic funding for HIV.

Despite the loss of funding, significant progress has been made to protect essential HIV treatment gains. South Africa currently funds 77% of its AIDS response, and its 2025 budget review includes a 3.3% annual increase for HIV and tuberculosis programs over the next three years. As of December 2024, seven countries in sub-Saharan Africa have achieved the 95-95-95 targets established by UNAIDS: 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed. UNAIDS emphasized the importance of this being scaled up to a global level.

Achrekar observed, referring to countries whose domestic funds towards AIDS have increased, that “prevention is the last thing that is prioritized, but we will never be able to turn off the tap of the new infections without focusing on prevention as well.”

She reiterated the importance of countries most affected by the HIV/AIDS crisis establishing self-sustaining health practices to ensure longevity in both prevention and treatment.

Achrekar praised the global South for their work in taking ownership of treatment while still calling upon the rest of the world to join.

She said, “The HIV response was forged in crisis, and it was built to be resilient. We need, and are calling for, global solidarity once again, to rebuild a nationally owned and led, sustainable and inclusive multi-sectoral HIV response.”

IPS UN Bureau Report

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For the Aged, Their Sunset Years Will Be Bedeviled by Lethal Heatwaves

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Climate Change

Facing frequent climate hazards, resultantly offsprings having migrated out, this South Sikkimese elder in India battles depression, anxiety and early onset of dementia. Credit: Manipadma Jena/IPS

Facing frequent climate hazards, resultantly offsprings having migrated out, this South Sikkimese elder in India battles depression, anxiety and early onset of dementia.
Credit: Manipadma Jena/IPS

NAIROBI & BHUBANESWAR, Jul 10 2025 (IPS) – The global population is aging at a time when heat exposure is rising due to climate change. Extreme heat can be deadly for older populations given their reduced ability to regulate body temperature. Already there has been an 85 percent increase since 1990 in annual heat-related deaths of adults aged above 65, driven by both warming trends and fast-growing older populations.

If this were not heartbreakingly disastrous enough, heat-related deaths in older populations are projected to increase by 370 percent annually if global temperatures rise by 2˚ Centigrade mid-century. The world is currently on track to reach 2.7°C by the end of the century, up from 1.14°C above pre-industrial levels in 2013-2022.

With 2024 the hottest year ever recorded and the past 11 years declared the 11 warmest on record since records began in 1880, the World Meteorological Organization (WMO) report warning of an 80% chance that 2025-2029 will be warmer than 2024, predicting severe climate impacts, and nearing the 1.5°C warming threshold is alarming if not surprising.

As extreme heat grips many countries and becomes ‘the new normal,’ the UN Environment Programme (UNEP) warns of heightened health risks for older persons in the Frontiers 2025 Report published today.

Older persons, especially those with chronic illnesses like diabetes, hypertension and heart ailments, limited mobility, or age-related frailty, are particularly vulnerable to severe health issues, depending on the intensity, duration, and frequency of heat spells. These could range from respiratory and cardiovascular to metabolic diseases, as well as increased mortality.

Inger Andersen, Executive Director of UNEP said solutions exist that can help protect communities and ecosystem. Courtesy: UNEP

Inger Andersen, Executive Director of UNEP said solutions exist that can help protect communities and ecosystems. Courtesy: UNEP

“Heat waves are among the most frequent and deadly impacts of climate change, along with floods and shrinking ice cover,” said Inger Andersen, Executive Director of UNEP. “We must be prepared for the risks these impacts pose, especially for society’s most vulnerable, including older persons.”

The 7th edition of the Frontiers Report, The Weight of Time – Facing a new age of challenges for people and Ecosystems, is part of UNEP’s Foresight Trajectory initiative and highlights emerging environmental issues as well as doable solutions. The first edition, in 2016, warned of the growing risk of zoonotic diseases, four years before the COVID-19 pandemic.

Those worst effected by rising temperatures: where and why

“The (third) issue is the risk to aging populations from environmental degradation. It is estimated that the global share of people over 65 years old will rise from 10 percent in 2024 to 16 percent by 2050. Most of these people will live in cities where they will be exposed to extreme heat and air pollution, and experience more frequent disasters. Older people are already more at risk. Effective adaptation strategies will need to evolve to protect these older populations,” says UNEP’s Executive Director, Inger Andersen.

Projections indicate that heatwaves will become more intense, frequent and persistent in nearly all regions. As heatwaves intensify, scientists warn of the amplified danger when extreme heat and humidity combine. Higher humidity tends to limit the human body’s ability to cool itself through the evaporation of sweat.

When temperatures rise by 1o C, estimates peg 275 million people will be exposed to humid heatwaves. The impact will shoot up to 789 million with 2o C, and with an apocalyptic 3oC rise, 1220 million people will be battling absolutely lethal humid heatwaves.

Already experiencing humid heatwaves are low-lying tropical regions of India and Pakistan, the Persian Gulf, the Arabian Gulf, the Red Sea, and eastern China.

Urban centers usually experience higher temperatures than surrounding rural areas because buildings, pavement, and other artificial surfaces trap, retain and re-radiate heat. This urban heat island effect and heat waves interact synergistically, exposing urban residents to greater heat and amplifying health risks.

Developing and low-income countries that are urbanizing at a fast pace are more at risk.

Rural-to-urban migrants often live in tin- or asbestos-roofed one-roomed houses, crowded and ill-ventilated, in informal settlements that spring up in low-value, hazardous land parcels without water supply, sanitation or electricity facilities. In recent hotter years, surveys have found the temperature inside these housing units is even higher than the ambient high heat outside on heat-wave days. Often poorer parts of cities have less green and heat up faster. Worse, night temperatures are not cooling down in cities owing to the heat-island effect.

Older adults who are uprooted from their traditional communities into cities, are socially isolated, economically disadvantaged, have cognitive, physical, or sensory impairments, and live in substandard housing with inadequate cooling systems or even basic water, are especially ill-equipped to withstand or adapt to heat extremes, say other studies.

Are only the elderly in low- and middle-income countries at heat risk? Latest reports suggest even the developed countries cannot protect their aged from growing climate heat.

A first rapid study released earlier in July by scientists at the Grantham Institute at Imperial College London and the London School of Hygiene & Tropical Medicine focused on ten days of heatwaves in 12 European cities from June 23 to July 2, 2025. The researchers estimated that climate change nearly tripled the number of heat-related deaths, with fossil fuel use having increased heatwave temperatures up to 2°C – 4°C across the cities.

Of the 2,305 estimated heat deaths in those ten days, people aged 65-plus made up 88 percent of the deaths, highlighting how those with underlying health conditions are most at risk of premature death in heatwaves.

“It is society’s most vulnerable … who suffer most in the midst of record temperatures. Europe’s dependence and soft hand on oil and gas corporations who are fueling this extreme heat is giving a death blow to our parents and grandparents,” said Ian Duff, Head of Greenpeace International’s ‘Stop Drilling Start Paying’ campaign, called on polluters to pay up.

It is not heat alone that the aged are vulnerable to

Exposure to air pollutants such as fine particulate matter, ground-level ozone, nitrogen dioxide and sulfur dioxide often triggers the onset and progression of a variety of respiratory, cardiovascular, neurological and cognitive illnesses and related deaths in older people, according to the Frontier report.

Nearly half of the 1.24 million deaths attributable to air pollution in India in 2017 were those aged 70 years or older.

Accelerating climate change that brings extreme heat, worsening air pollution, drought and dust storms, floods and melting glaciers is, in multiple ways, directly and indirectly, not only responsible for physical ailments but also for the development of dementia, late-life depression, anxiety and mental health in elders.

Building climate resilience for aging population: the time is now

“As this year’s Frontiers Report shows, solutions exist that can help protect communities and restore ecosystems long thought to have been lost,” Inger Andersen urges governments to implement adaptation strategies.

On its part, the report recommends transforming cities into age-friendly, pollution-free, resilient, accessible spaces with expansive vegetation through better urban planning.

Community-based disaster risk management and access to climate information are key approaches to help aging people adapt successfully to climate change. Investing in weather stations to monitor extreme heat is critical to protect lives.

The digital divide among older populations in cities needs to be addressed. Digital ignorance may affect their capacity to live in smart cities and be adequately informed of possible extreme events that may affect their survival. Otherwise too, day-to-day living—banking, medicine purchases, and shopping for essentials—are all going digital and, once mastered, convenient to the aged.

IPS UN Bureau Report

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Multi-Year Drought Gives Birth to Extremist Violence, Girls Most Vulnerable

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Combating Desertification and Drought

In Nairobi’s Kibera, the largest urban informal settlement in Africa, girls and women wait their turn for the scarce water supply. Credit: Manipadma Jena/IPS

SEVILLE & BHUBANESWAR, Jul 2 2025 (IPS) – While droughts creep in stealthily, their impacts are often more devastating and far-reaching than any other disaster. Inter-community conflict, extremist violence, and violence and injustice against vulnerable girls and women happen at the intersection of climate-induced droughts and drought-impoverished communities.

Five consecutive years of failed rain in Ethiopia, Somalia, and Kenya brought the worst drought in seventy years to the Horn of Africa by 2023. In Somalia, the government estimated 43,000 excess deaths in 2022 alone due to drought-linked hunger.

As of early current year, 4.4 million people, or a quarter of Somalia’s population, face crisis-level food insecurity, including 784,000 people expected to reach emergency levels. Together, over 90 million people across Eastern and Southern Africa face acute hunger. Some areas have been enduring their worst ever recorded drought, finds a United Nations-backed study, Drought Hotspots Around the World 2023-2025 released today at the 4th International Conference on Financing for Development (FfD4).

UNCCD Executive Secretary Ibrahim Thiaw said "Drought is here, escalating, and demands urgent global cooperation" Photo courtesy: UNCCD

UNCCD Executive Secretary Ibrahim Thiaw noted that while drought is here and escalating, it demands urgent global cooperation. Photo courtesy: UNCCD

High tempera­tures and a lack of precipitation in 2023 and 2024 resulted in water supply shortages, low food supplies, and power rationing. In parts of Africa, tens of millions faced drought-induced food shortages, malnutrition, and displacement, finds the new 2025 drought analysis, Drought Hotspots Around the World 2023-2025, by the UN Convention to Combat Desertification (UNCCD) and the U.S. National Drought Mitigation Center (NDMC).

It not just comprehensively synthesizes impacts on humans but also on biodiversity and wildlife within the most acute drought hotspots in Africa (Somalia, Ethiopia, Zimbabwe, Zambia, Malawi, Botswana, and Namibia), the Mediterranean (Spain, Morocco, and Türkiye), Latin America (Panama and the Amazon Basin) and Southeast Asia.

Desperate to Cope but Pulled Into a Spiral of Violence and Conflict

“The coping mechanisms we saw during this drought grew increasingly desperate,” says lead author Paula Guastello, NDMC drought impacts researcher. “Girls pulled from school and forced into marriage, hospitals going dark, and families digging holes in dry riverbeds just to find contaminated water. These are signs of severe crisis.”

Over one million Somalis in 2022 were forced to move in search of food, water for families and cattle, and alternative livelihoods. Migration is a major coping mechanism mostly for subsistence farmers and pastoralists. However, mass migration strains resources in host areas, often leading to conflict. Of this large number of displaced Somalis, many crossed into territory held by Islamic extremists.

Drought in a Sub-Saharan district leads to 8.1 percent lower economic activity and 29.0 percent higher extremist violence, an earlier study found. Districts with more months of drought in a given year and more years in a row with drought experienced more severe violence.

Drought expert and editor of the UNCCD study Daniel Tsegai told IPS at the online pre-release press briefing from the Saville conference that drought can turn into an extremist violence multiplier in regions and among communities rendered vulnerable by multi-year drought.

Climate change-driven drought does not directly cause extremist conflict or civil wars; it overlaps and exacerbates existing social and economic tensions, contributing to the conditions that lead to conflict and potentially influencing the rise of extremist violence, added Tsegai.

Extracting water from a traditional well using a manual pulley system. Credit: Abdallah Khalili / UNCCD

Extracting water from a traditional well using a manual pulley system. Credit: Abdallah Khalili / UNCCD

Though the effects of climate change on conflict are indirect, they have been seen to be quite severe and far-reaching. An example is the 2006-2011 drought in Syria, seen as the worst in 900 years. It led to crop failures, livestock deaths and mass rural displacement into cities, creating social and political stress. Economic disparities and authoritarian repression gave rise to extremist groups that exploited individuals facing unbearable hardships.

The UN study cites entire school districts in Zimbabwe that saw mass dropouts due to hunger and school costs. Rural families were no longer able to afford uniforms and tuition, which cost USD 25. Some children left school to migrate with family and work.

Drought-related hunger impact on children

Hungry and clueless about their dark futures, children become prime targets for extremists’ recruitment.

A further example of exploitation of vulnerable communities by extremists is cited in the UNCCD drought study. The UN World Food Programme in May 2023 estimated that over 213,000 more Somalis were at “imminent risk” of dying of starvation. Little aid had reached Somalia, as multiple crises across the globe spread resources thin.

However, al-Shabab, an Islamic extremist group tied to al-Qaida, allegedly prevented aid from reaching the parts of Somalia under its control and refused to let people leave in search of food.

Violent clashes for scarce resources among nomadic herders in the Africa region during droughts are well documented. Between 2021 and January 2023 in eastern Africa alone, over 4.5 million livestock had died due to droughts, and 30 million additional animals were at risk. Facing starvation of both their families and their livestock, by February 2025, tens of thousands of pastoralists had moved with their livestock in search of food and water, potentially into violent confrontations with host regions.

Tsegai said, “Drought knows no geographical boundaries. Violence and conflict spill over into economically healthy communities this way.”

Earlier drought researchers have emphasized to policymakers that “building resilience to drought is a security imperative.”

Women and Girls Worst Victims of Drought Violence

“Today, around 85 percent of people affected by drought live in low- and middle-income countries, with women and girls being the hardest hit,” UNCCD Deputy Executive Secretary Andrea Meza said.

“Drought might not know boundaries, but it knows gender,” Tsegai said. Women and girls in low-income countries are the worst victims of drought-induced societal instability.

Traditional gender-based societal inequalities are what make women and girl children par­ticularly vulnerable.

During the 2023-2024 drought, forced child marriages in sub-Saharan Africa more than doubled in frequency in the four regions hit hardest by the drought. Young girls who married brought their family income in the form of a dowry that could be as high as 3,000 Ethiopian birr (USD 56). It lessened the financial burden on girls’ parental families.

Forced child marriages, however, bring substantial risks to the girls. A hospital clinic in Ethiopia (which, though, it has outlawed child marriage) specifically opened to help victims of sexual and physi­cal abuse that is common in such marriages.

Girls gener­ally leave school when they marry, further stifling their opportunities for financial independence.

Reports have found desperate women exchanging sex for food or water or money during acute water scarcities. Higher incidence of sexual violence happens when hydropower-dependent regions are confronted with 18 to 20 hours without electricity and women and girls are compelled to walk miles to fetch household water.

“Proactive drought management is a matter of climate justice,” UNCCD Meza said.

Drought Hotspots Need to Be Ready for This ‘New’ Normal

“Drought is no longer a distant threat,” said UNCCD Executive Secretary Ibrahim Thiaw, adding, “It is here, escalating, and demands urgent global cooperation. When energy, food, and water all go at once, societies start to unravel. That’s the new normal we need to be ready for.”

“This is a slow-moving global catastrophe, the worst I’ve ever seen. This report underscores the need for systematic monitoring of how drought affects lives, livelihoods, and the health of the ecosystems that we all depend on,” said Mark Svoboda, report co-author and NDMC Founding Director.

“The struggles experienced by Spain, Morocco and Türkiye to secure water, food, and energy under persistent drought offer a preview of water futures under unchecked global warming. No country, regardless of wealth or capacity, can afford to be complacent,” he added.

Global Drought Outlook 2025 estimates the economic impacts of an average drought today can be up to six times higher than in 2000, and costs are projected to rise by at least 35% by 2035.

“It is calculated that $1 of investment in drought prevention results in bringing back $7 into the GDP lost to droughts. Awareness of the economics of drought is important for policymaking,” Tsegai said.

The report released during the International Drought Resilience Alliance (IDRA) event at the Saville conference aims to get public policies and international cooperation frameworks to urgently prioritize drought resilience and bolster funding.

IPS UN Bureau Report