Dozens of countries are facing severe oxygen shortages because of surging Covid-19 cases, threatening the “total collapse” of health systems.
The Bureau of Investigative Journalism analysed data provided by the Every Breath Counts Coalition, the NGO Path and the Clinton Health Access Initiative (CHAI) to find the countries most at risk of running out of oxygen. It also studied data on global vaccination rates.
Nineteen countries around the world – including India, Argentina, Iran, Nepal, the Philippines, Malaysia, Pakistan, Argentina, Costa Rica, Ecuador and South Africa – are deemed most at risk after recording huge increases in demand since March – at least a 20% rise – while having vaccinated less than 20% of their populations.
There are concerns that other Asian countries like Laos are at risk, and African countries including Nigeria, Ethiopia, Malawi and Zimbabwe, which have less mature oxygen delivery systems, meaning a small increase in need could create big problems.
Many of these countries faced oxygen shortages before the pandemic, said Leith Greenslade, coordinator of the Every Breath Counts Coalition. The extra need is pushing health systems to the brink.
“The situation last year, and again in January this year in Brazil and Peru, should have been the wake up call,” she said. “But the world did not wake up. We should have known India would happen after seeing what happened in Latin America. And now looking at Asia, we should know this will happen in some of the big cities in Africa.”
Robert Matiru, who chairs the Covid-19 Oxygen Emergency Taskforce, told the bureau: “We could see the total collapse of health systems, especially in countries with very fragile systems.”
Hospitals in India have reported significant shortages of oxygen as the country battles its second wave. By the middle of May, India needed an extra 15.5m cubic metres of oxygen a day just for Covid-19 patients, more than 14 times what it needed in March, according to the bureau’s analysis.
In response, India has banned all exports of liquid and cylinder oxygen.
But experts are worried about India’s neighbours – Pakistan, Nepal, Bangladesh, Sri Lanka and Myanmar – some of which rely on Indian-made oxygen and equipment.
“You’d imagine if they start to see peaks of the same degree, then it could be even worse, because India needs all the supply,” said Zachary Katz, vice-president of essential medicines at CHAI.
The bureau’s data shows that Nepal now needs more than 100 times as much oxygen as it did in March.
Demand for oxygen in Sri Lanka has risen sevenfold since mid-March. In Pakistan, which is suffering its third wave of cases, almost 60% more patients are on oxygen in hospital than during the country’s previous peak last summer, according to a government minister, who warned in late April that pressure on the oxygen supply was reaching dangerous levels.
“The mood is extremely grim,” says Dr Fyezah Jehan, a doctor in Karachi. “I think we are very scared of an India-like situation. We’re hoping that some magic happens, and this [current] lockdown can prevent a new onslaught of cases.”
“Rapidly rising need for oxygen puts pressure on the health system, which it can’t meet, and we see patient deaths,” said Greenslade. “And that will keep happening week after week, month after month, if the vaccine rollout is slow, because at this point, in many of these countries, it’s only increases in vaccine coverage that will bend the curve on transmission.”
The health systems of many poorer countries “could not be more ill-prepared”, Greenslade said. “From the head of state, the health minister, the finance minister … these countries haven’t prioritised oxygen as an essential medicine. As we see in India, many, many people have died and continue to die every day for lack of oxygen.”
Several countries have demanded that companies which produce liquid oxygen divert products from their industrial clients to hospitals. Medical oxygen makes up just 1% of global liquid oxygen production.
However, data from Gasworld Business Intelligence, which analyses the global industrial gases market, shows that many of the countries most in need would still see shortages even if alllocal oxygen production was diverted to hospitals.
In Iraq, gas companies can produce about 64,000 cubic metres of liquid oxygen a day, a third of what the country’s Covid-19 patients need. In Colombia, the industry can only provide 450,000 cubic metres a day, less than two-thirds of what is needed.
In Peru, gas companies can only reach 80% of the oxygen it needs if all oxygen was diverted to healthcare. “Currently, Peru is registering a drop in [Covid] cases,” said Dr Jesús Valverde Huamán, who works in an ICU in Lima. “However, we are still in need of medical oxygen, especially for hospitals.” It has been a constant struggle to find enough oxygen for patients, he said, apart from a short stretch in November and December last year, when cases dipped.
Greenslade said: “We have to ask a very critical question: why such an essential resource as oxygen is locked up in mining, steel, oil and gas when the poor public hospital system can’t provide enough to keep babies, adults and the elderly alive.
“These countries have to take a good look at how they’re investing in medical oxygen in the health system. If oxygen capacity is there for mining companies to extract, the capacity must be there for the health system to save lives.”
While liquid oxygen is a major source for medics in many countries, it does not account for all of the supply. Hospitals can also obtain oxygen from on-site factories that turn ambient air into oxygen, and from portable concentrator machines.
The World Health Organization, Unicef, the World Bank and other donors and NGOs have shipped hundreds of thousands of concentrators to countries to help them deal with rises in oxygen needs, but manufacturers are running short of parts.
The World Bank has warned that many countries have not applied for emergency loans available to help them upgrade oxygen systems. Last year the World Bank made $160bn (£113bn) available for countries to prepare for Covid-19 and added an additional $12bn this month. The cash can be used to import oxygen or shore up production.
Unitaid and Wellcome have donated $20m in emergency funding for oxygen in low-income countries. The Global Fund has also made $13.7bn in grants available for countries to use on Covid-19 response programmes, including to buy oxygen concentrators and build public oxygen plants.
Campaigners want emergency, fast-tracked funding for oxygen supplies anywhere in the world.
But Mickey Chopra, a senior official at the World Bank, said countries had applied for loans for ventilators and PPE but not for oxygen supplies. “The variants and the sudden spikes that we’ve seen now have caught people by surprise, to a large extent, and the weakest point in the system has turned out to be the oxygen supply system.”
Looking ahead, Greenslade would like to see governments create comprehensive national medical oxygen strategies, with workers trained to give patients oxygen safely and maintain and fix equipment.
Countries need to have plans in place for unexpected rises in demand, she said. “What they’re doing at the moment is when a crisis hits, [governments] scramble to bring a group together to come up with some way of managing it. But they need to get ahead of the game.”
Additional reporting by Oksana Grytsenko, Anmol Irfan, Ivan Ruiz, Rizwan Shehzad, Natalie Vikhrov, Claudia Chavez and Ralph Zapata
The funeral of a Roma man killed while in Czech police custody was held over the weekend. Stanislav Tomáš died after a Czech police officer kneeled on his neck, in scenes reminiscent of the murder of George Floyd by a US police officer in Minneapolis. Tomáš passed away 19 June, while being rushed to the hospital. The police have denied wrongdoing.
US House Speaker Nancy Pelosi (D-CA) confirmed on Sunday that Rep. Adam Kinzinger (R-IL) has been appointed to serve on the US House-approved select committee probing the January 6 attack on the US Capitol building. This move comes days after Pelosi rejected two out of five GOP recommendations from House Minority Leader Kevin McCarthy (R-CA).
“Some Republicans have been saying … that the GOP should play ball on this committee. You could get the three,” a reporter asked in reference to Reps. Rodney Davis (R-IL), Kelly Armstrong (R-ND) and Troy Nehls (R-TX).
All three lawmakers received Pelosi’s approval for appointment, but they were ultimately held back by McCarthy, who demanded the House Speaker also appoint Reps. Jim Jordan (R-OH) and Jim Banks (R-IN). Pelosi has asserted that Jordan and Banks would endanger the probe’s “integrity.”
McCarthy brushed the reporter’s suggestion aside, arguing that Cheney and Kinzinger are the only House Republicans who would “play ball” in an effort for the commission to have a bipartisan quorum.
“Who is that, Adam [Kinzinger] and Liz [Cheney]?” he floated. “Arent they kinda, like, Pelosi Republicans?”
“We’ve got very serious business here. We have important work to do,” she asserted to reporters on Monday.
Both Cheney and Kinzinger are slated to meet up with their Democratic colleagues for their first select committee meeting on Tuesday. The group’s first witness is also expected to make an appearance.
Presently, Democrats on the 13-member group include Rep. Bennie Thompson (D-MS), chairman of the select committee, Zoe Lofgren (D-CA), Adam Schiff (D-CA), Pete Aguilar (D-CA), Stephanie Murphy (D-FL), Jamie Raskin (D-MD) and Elaine Luria (D-VA). Kinzinger and Cheney are the sole GOP lawmakers assigned to the committee.
McCarthy has maintained that Pelosi is pursuing a “sham process” by rejecting Jordan and Banks from the select committee.
U.S. House Minority Leader Kevin McCarthy (R-CA) announces the withdrawal of his nominees to serve on the special committee probing the Jan. 6 attack on the Capitol, as two of the Republican nominees, Reps’ Jim Jordan (R-OH) and Jim Banks (R-IN), standby during a news conference on Capitol Hill in Washington, U.S., July 21, 2021
“Speaker Pelosi’s rejection of the Republican nominees to serve on the committee and self-appointment of members who share her preconceived narrative will not yield a serious investigation,” McCarthy wrote on Sunday, shortly after Pelosi announced Kinzinger’s appointment. “The Speaker has structured this select committee to satisfy her political objectives. She had months to work with Republicans on a reasonable and fair approach to get answers on the events and security failures surrounding January 6.”
Republicans have also argued that the investigation should focus on why the US Capitol was not properly secured on January 6, despite reports claiming law enforcement had information leading up to the attack.
“The U.S. Capitol and the men and women who protect it suffered a massive leadership failure. We must make sure that never happens again,” the House Minority Leader noted on Sunday, claiming the GOP will carry out its own probe on the deadly riot.
On the wide, flat plain of the Sinjar district of northern Iraq, Naif Khalaf Qassim lets his dog, an eight-year-old Belgian shepherd, range across the dry earth on a 30-metre leash until Branco stops and sits, tail wagging, looking towards his handler with enthusiasm.
Branco has detected something underground and, when the mine-clearing team is brought in to investigate, they find an improvised explosive device (IED), known locally as a VS500.
It is about 30cm (1ft) wide, with a plastic casing and a central pressure pad. The VS500 is not the name Islamic State give the device; no one knows that. All that is certain is that it is one of thousands produced when the terror group held sway over this part of Iraq and commandeered plastics factories in their Mosul base, forcing the workers to make souped-up versions of the Italian-made VS50 landmine.
A VS50 could fit on the palm of your hand, and contains about 100g of explosives. The deminers call this type of mine the VS500 because it is 10 times the size and packed with up to 15kg (33lb) of explosives. The pressure pad is sensitive enough for a child to activate, even through 30cm of packed earth. The explosion can take out an armoured vehicle.
Branco is trained to sniff ahead in a controlled manner and stop if he gets a scent – so he doesn’t tread on the mine. Belgian and German shepherds are used because they are most adept at distinguishing scents.
“I knew Branco would find the IED,” says Naif proudly. “I believe in him and his abilities; I know him and what he can do. He is more of a friend to me than a dog.”
Four years ago, Iraqi forces managed to take the last stronghold that Isis had left in the country, the city and surroundings of Tal Afar. The Iraqi flag was raised on the historic Ottoman citadel at the heart of the city, and the militia was pushed into Syria.
The war might have appeared over by late August 2017, but retreating Isis forces seeded the towns, villages and countryside in that area of Sinjar with IEDs, and the job of clearing them is still far from done.
But it is moving at a much faster pace, thanks to the introduction of the small sniffer dog team, including Branco, and his handler, Naif, 35.
Mine-detection dogs are not new – the British-based Mines Advisory Group (MAG) has been working across northern Iraq for three decades. In the year from June 2020 to June 2021 the Iraqi dog team has found and destroyed 3,540 landmines and explosive remnants of war, including 670 improvised mines and 148 other improvised devices.
Now MAG has embarked on a specific programme to better detect the explosives used by Isis and other non-state groups.
Dogs are usually trained to sniff out explosives, mainly TNT, but the IED dogs take this a step further. Trained in Bosnia-Herzegovina, their noses are attuned to rubber, metal and batteries as well.
This is key where explosives are often improvised from domestic items such as pots and kettles, with detonators and batteries. Training dogs to focus on a wider range of scents allows for more opportunities to detect anomalies below the surface.
The new four-strong dog team (with two more on their way from Bosnia-Herzegovina) is currently working on 8sq km of land near Tal Afar that was used as a barrier minefield by retreating Isis fighters in 2017. While people armed with mine detectors painstakingly scour a known mined corridor, the dogs range across the areas either side, deemed low or medium risk, to seek out any randomly planted devices.
The programme for the “super-detector” dogs was curtailed until now by Covid and by difficulties negotiating with the administration in Sinjar – divided between the Iraqi federal government and the Kurdistan regional government.
The dogs start work at 5am, so that they can finish before the sun is too high – last week temperatures there hit 49C (120F). The handlers are from the Yazidi community.
Vian Khaider Khalaf, 26, was a student before starting work with the dogs in 2017. She works to support her family in Sinuni, but like everyone on the team, her driving motivation is to clear the mines so that families can return to their farms.
“We always had dogs at home, as my family are farmers and shepherds,” says Khalaf. “I fled with my family in 2014 when Daesh [Isis] came. I still have family in an IDP [internally displaced people] camp in Kurdistan. My family are afraid for me, of course. But they are proud of me and see me working hard and bravely, and that makes me want to take on more challenges.”
Khalaf has worked with her dog, X-Lang, since she started with MAG. He was originally a mine-detector dog, but was selected for the IED upgrade training. She says: “The relationship between me and my dog is not really that of a human and an animal. He is my dear friend. If I could take him home with me at the weekend, or live on the base with him, I would.”
After their shifts out in the fields, handlers and dogs spend the rest of the day together, often around the pool on the base.
The team supervisor is Salam Rasho, a former noncommissioned officer with the Kurdistan military, the peshmerga. He is also a Yazidi and has seen the devastation of his community. “Our aim is to return the people to their land, to get people farming the land again,” he says.
It’s impossible to estimate how much unexploded ordnance there is in Iraq – one of the most mined countries in the world, according to some estimates. There is little information about where mines were laid over the past 40 years, from the Iran-Iraq war in the 1980s, to Saddam Hussein’s assaults on his own people, the Gulf War, and finally Isis. It is thought that in federal Iraq alone there are some 3,000 sq km of mined land yet to be cleared, with 8.5 million people living in close proximity.
The real benefit of the dogs, says Salam, is that they can cover a huge area much quicker than humans – about 1,500 sq metres a day. The success of the Iraq deployment means that MAG is stepping up its IED dog training and even going to the next level – finessing the programme so that dogs can also be used to help clear booby-trapped homes.
Clearing Iraq of unexploded mines is a task that will take many more years, but at least now the land is being freed from the lingering grip of Isis at a faster pace than before thanks to Branco, X-Lang and the other dogs of war.