Ineffective health care is a global phenomenon which increases the burden of illness and wastes scarce resources, UN experts said on Thursday.

In a new report on the subject, the World Health Organization (WHO) and partners cited problems with delivering quality health care across all Member States.

The finding is important because, although nations have committed to providing universal health coverage by 2030, the outcome “would still be poor” without the delivery of effective care, WHO says.

“Inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices — or providers who lack adequate training and expertise — prevail in all countries,” the agency said in a statement.

The challenge is greatest in low- and middle-income countries, where 10 per cent of hospital patients acquire an infection during the course of their stay, compared to 7 per cent elsewhere.

In some poorer nations, moreover, clinical guidelines are followed in less than 50 per cent of cases, resulting in “low-quality antenatal and childcare”, as well as “deficient” family planning, according to the report by WHO, the World Bank and the Organization for Economic Cooperation and Development (OECD).

Inadequate clinical practice was also “common” in private and public clinics in several low- and middle-income countries, the study found, with some demonstrating diagnostic accuracy as low as 34 per cent.

Ensuring quality health care for everyone is essential, it says, primarily because it prevents suffering, but also since it helps to boost economic productivity.

Furthermore, failing to treat sick people results in increased financial pressure on families and health systems which amounts to trillions of dollars each year, the report notes.

Highlighting the dangers of ineffective health coverage when faced with a public health emergency, the report notes that in Liberia, inadequacies there allowed the 2014 Ebola epidemic “to proliferate rapidly”.

It found that the virus exposed “largely absent” infection prevention and control where it was most needed, along with several “persistent” systemic constraints.

These included a lack of skilled professionals in communities, as well as an absence of financing mechanisms, distribution networks and information procedures.

Following the outbreak, an investment plan was put in place to help the West African nation’s ability to tackle future health emergencies, involving the provision of essential services and improving community confidence in health systems.

Underscoring the fact that the problem crosses all economic boundaries, the report found that richer countries had problems too, with breast-screening rates as low as 19 per cent and influenza vaccination rates below 30 per cent, in 35 nations.

Findings from high-income countries also indicated that 1 in 10 patients is harmed during medical treatment, and that around 15 per cent of hospital expenditure can be put down to mistakes in care or having to treat patient infection.

Despite the challenges, the report noted some progress in improving the quality of care, for example in survival rates for cancer and cardiovascular disease.

In an appeal to Governments to promote stronger national health-care quality policies, the three co-authors of the report emphasized their rejection of the perception that quality health care is a “luxury that only rich countries can afford”.

Finally, noting that technological innovation already “plays a key role” in offering ways to expand high-quality health-care services rapidly and affordably, the report also finds that “many” low- and middle-income countries have developed successful strategies to improve the quality of health coverage, but all that is missing is a global platform to share this knowledge.

Myanmar should “have some shame” after attempting to convince the world that it is willing to take back hundreds of thousands of refugees who fled an “ethnic cleansing campaign” last year, given that “not a single” one has returned officially, the United Nations human rights chief warned on Wednesday.

Addressing the Human Rights Council after giving an update on the refugee crisis that has seen more than 700,000 Rohingya people flee to Bangladesh to escape a security clampdown in Myanmar, Zeid urged the UN Security Council to refer the Member State to the International Criminal Court (ICC) immediately.

“We are not fools,” he said.

The High Commissioner for Human Rights also responded to the Myanmar Government representative’s comments that it was a “body committed to the defence of human rights”.

This, Mr. Zeid said, “almost creates a new category of absurdity” – a first during his mandate as the UN’s top human rights official.

“In the four years that I have been High Commissioner I have heard many preposterous claims,” he said. “This claim, that I have just stated now, almost creates a new category of absurdity. Have some shame sir. Have some shame. We are not fools.”

Earlier at the Human Rights Council, Mr. Zeid said that Myanmar had “expended considerable energy” challenging allegations that its security forces carried out ethnic cleansing against the mainly Muslim Rohingya.

Not a single Rohingya refugee has returned under the formal framework agreed with Bangladesh – High Commissioner Zeid

In January, he continued, the Government of Myanmar had signed a repatriation deal with Bangladesh, which continues to host the communities who fled their homes last August.

Despite this agreement, “not a single Rohingya refugee has returned under the formal framework agreed with Bangladesh”, he said, while “many – if not all – of those who have returned … have been detained”.

Citing one example, the High Commissioner said that between January and April this year, 58 Rohingya who returned were arrested and convicted on unspecified charges.

“They then received a Presidential pardon, but have simply been transferred from Buthidaung prison (in northern Rakhine province) to a so-called ‘reception centre’,” he explained.

All the while more Rohingya continue to seek shelter in Bangladesh, he continued, noting that as of mid-June, there have been 11,432 new arrivals there.

On the issue of ICC involvement in the issue, as he had urged, Mr. Zeid noted that the results of its fact-finding mission to Myanmar were due to be submitted “in a matter of weeks”.

UN rights chief calls for access to northern Rakhine

The UN official also repeated a call for access to northern Rakhine state on behalf of the Human Rights Council and his own office, OHCHR.

Myanmar should do this “instead of coming out with one bogus national commission after another”, the High Commissioner said – a reference to the country’s recent announcement that it intended to set up an “Independent Commission of Enquiry” to investigate alleged rights violations by Rohingya militants known as the Arakan Rohingya Salvation Army (ARSA) last year.

While the Government claimed these attacks the cause of the current crisis, the UN rights chief explained that this was not possible since “cycles of violence” against the Rohingya “long pre-date ARSA, which was reportedly established in 2013”.

Barring any special meetings called by the Council after this 38th scheduled session, Mr. Zeid’s address was his last in his official capacity as UN High Commissioner for Human Rights before he steps down.

Noting this, he cautioned that “if a Member State of this organization can force out 700,000 people in almost three weeks, with practically minimal response by the International Community, then how many others in this Chamber are beginning to entertain something similar?”

Myanmar, speaking as a concerned country, said that many of the allegations in the address by the High Commissioner were flawed, incorrect and misleading. ARSA had  committed heinous and shocking atrocities, its delegatation said, adding that the root cause of the tragedy was terrorism. On the subject of repatriation, Myanmar was doing its utmost to repatriate the displaced persons as soon as possible, the delegation insisted.

In Mali, a senior United Nations rights expert on Wednesday described an “alarming” deterioration of the security, human rights and humanitarian situation in northern and eastern areas of the country.

Alioune Tine’s comments follow two deadly attacks in recent days on international forces in Mali, including one suicide bombing in Gao, that left at least two civilians dead and more than 15 injured.

In Menaka, to the east, more than 120 people were also allegedly murdered in a three-week period in April and May, he said in a statement, noting that that violent extremists had taken advantage of the lack of basic services “to exploit communities and pit them against each other”.

Some attacks have been attributed to armed groups including the Azawad Salvation Movement (MSA) and the Touareg IMGHAD Self-Defense Group and Allies (GATIA), the UN expert noted.

Amid ongoing insecurity, which has been characterized by kidnappings and targeted killings, according to the Senegalese expert, communities have been displaced and more than 650 schools have been forced to close in central and northern regions, affecting nearly 200,000 children.

There have also been an increasing number of allegations of “serious human rights violations” against the Malian armed forces, Mr. Tine said, echoing concerns about anti-terrorist operations “that do not respect international human rights standards”.

In an appeal to the Government of Mali to bring the perpetrators of rights abuses to justice, Mr. Tine underlined the “very limited State presence”, adding that in some central areas there is “none at all”.

The Independent Expert – who visited the country at the end of June – also commended the country’s Prime Minister for reaffirming that the Government will not tolerate any wrongdoing against civilians.

Turning to the humanitarian emergency in the central region and warning that it “is getting worse”, the UN expert said that 4.1 million people need food aid.

The number of people suffering from severe acute malnutrition in 2018 is also set to increase from 163,000 to well over a quarter of a million – including more than 11,000 children under five – he added.

Moderate acute malnutrition is a massive and chronic problem too, with numbers expected to increase from 470,000 to 582,000, including more than 45,000 pregnant and breastfeeding women.

“This is an emergency to which we cannot close our eyes,” Mr. Tine said, before appealing to armed groups to respect humanitarian workers as they carry out their work.

Ahead of Presidential elections at the end of this month, he urged all those engaged in it “to ban hate speech and calls to violence” during campaigning which begins in three days.

The rights expert also stressed the need to respect freedom of assembly and association, and freedom of access to the media, and appealed for the forthcoming presidential election to be “truly free, transparent and peaceful”, and to meet international standards.

Mr. Tine – who took office as Independent Expert on the situation of human rights in Mali on 1 May – will present his report to the Human Rights Council in March next year.

Among its findings, it’s expected to include an appraisal of a UN Security Council resolution agreed last year which established a targeted sanctions regime on the country.

Simple shelters that are little more than huts with bamboo sticks and plastic sheeting for walls, and tarpaulins overhead, are serving a very important purpose for refugee women and girls forced to flee their homes to the vast refugee camps of Bangladesh. 

They are offering persecuted Rohingya who fled the brutal violence in Myanmar a safe haven where they can find sanctuary and support, care of UN workers and partner agencies.

Some 19 Women-Friendly Spaces (WFS), also known as women’s centres or women’s safe spaces, set up by the United Nations Population Fund (UNPFA) cater to hundreds-of-thousands of women and girls, providing healthcare and counselling, as well as professional case management for survivors of violence.

However, with the start of the monsoon season, torrential rains and risk of flash floods and landslides, are jeopardizing this vital element of humanitarian response and protection. In June, some 10 such Spaces were damaged by rains and landslides.

“The heavy rains and their impact are already compounding the suffering of these refugees, even as they try to rebuild their lives,” Natalia Kanem, the Executive Director of UNFPA, said on Monday when she was in Cox’s Bazar, as part of Secretary-General António Guterres’ delegation.

Many of the women and girls in need of most care, are survivors of brutal crimes of sexual violence, carried out allegedly by Myanmar government forces, who began torching the villages of Rohingya in Rakhine state last August, forcing them to flee across the border.

UNFPA has already stepped up efforts and is working with partners, including other agencies, including the UN Children’s Fund (UNICEF) and the Office of the UN High Commissioner for Refugees (UNHCR) – together with refugees themselves and host communities – to repair and reinforce these spaces as well and the health centres operated by the agency.

UNFPA Bangladesh/Allison Joyce

Two women exit a Women-Friendly Space at a Rohingya refugee settlement in Cox’s Bazar, Bangladesh.

It is also identifying at-risk groups to they can be transferred to safety, forming community watch groups from among refugee and host community women, to locate those who are pregnant – often as a result of rape. Vulnerable women and girls, are taken to more secure settlements or places with facilities designed to help them cope with trauma and loss.

Midwives and case workers, supported by UNFPA are also traveling along waterlogged roads to reach those in need. However, it is feared that full brunt of the monsoon season will discourage women from seeking vital maternal health care and other services. 

The safety of the Rohingya refugees during this monsoon season is priority one – Secretary-General Guterres

During the recent first heavy rains, UNFPA health facilities and women-friendly spaces saw their use decline by around 60 per cent.

As a precaution, the UN agency has been distributing sterile delivery kits – which include a plastic sheet, razor blade, gloves and towels – to pregnant women to minimize infection risks during childbirth, in case they are unable to reach a health facility when it is time to deliver. More than 12,000 such kits have been distributed in the past nine months.

UN Secretary-General Guterres, who visited the refugee settlement and the UNFPA facilities on Monday, reiterated the need to protect those in most need.

“The safety of the Rohingya refugees during this monsoon season is priority one,” he said, standing amid a monsoon downpour.

Poorer countries with rising populations and scarce natural resources are likely to be “increasingly dependent” on imports to feed their people, according to an annual report jointly compiled by the United Nations food agency, launched on Tuesday.

Although overall exports from countries and regions with plenty of agricultural land are forecast to increase, the OECD-FAO Agricultural Outlook 2018-2027 stressed that because agricultural trade plays an important role in food security, there needs to be an enabling trade policy environment.

According to the Agricultural Outlook, undernourishment is concentrated in conflict-riddled and politically-unstable countries – with the Middle East and North Africa (MENA) facing simultaneous challenges of food insecurity, rising malnutrition and managing limited natural resources.

The report forecasts strong growth in agriculture and fishing in developing regions whose populations are rising fast, including Sub-Saharan Africa, South and East Asia and MENA. These areas are facing the challenge of limited land and water resources as well as extreme-weather related issues of climate-change, resulting in high dependence on food imports.

By contrast, this growth is predicted to be significantly lower in developed countries, particularly across Western Europe.

“The Green Revolution of the last century largely increased the world’s capacity to feed itself but now we need a sustainability revolution,” said José Graziano da Silva, Director General, Director General of the Food and Agriculture Organization (FAO), presenting the report with Angel Gurría,  Secretary-General of the Organisation for Economic Co-operation and Development (OECD). 

“This includes tackling high-input and resource-intensive farming systems that impose a high cost to the environment,” he added, noting the continued degradation of soil, forests, water, air quality and biodiversity.

The Agricultural Outlook recommends that regional countries re-orient policies away from cereals that require intensive watering, toward rural development, poverty reduction and farming of higher-value horticulture products.

“We need to adopt sustainable and productive food systems that offer healthy and nutritious food, while also preserving the environment and biodiversity,” stressed Mr. da Silva.

Elsewhere in MENA, population growth is prompting a rise in food demand where exceptionally high wheat consumption coupled with skyrocketing sugar and fat consumption are leading to what FAO calls “an alarming spread of overweight and obesity.”

FAO/Ami Vitale

Fresh produce for sale at a street market in Giza, Egypt.

The global front

Anticipating global improvements in agricultural commodities and food productivity, the report predicts a slide in demand, which will reduce the price of most food staples, over the coming decade.

The report attributes the slowdown to stagnating per-capita consumption of staple foods, a drop in emerging economy consumption, and a gradual decline in global population growth rates. 

Moreover, a decline in the desire to buy meat products will put a brake on the demand for cereals and protein meal used in animal feed. 

With slower consumption and production growth, agricultural and fish trade are projected to grow at about half the rate of the previous decade.