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
Maqsooda Bibi, 62, did not know the house she had lived in all her life would be demolished, forcing her whole family to become homeless. But on Monday, Pakistan’s supreme court backed the Sindh government in bulldozing her home and hundreds of others, legalising the eviction of thousands who live along narrow waterways – nullahs – that crisscross Karachi.
The verdict came as Bibi and hundreds of others held a protest outside the court. “We hoped that the court would ask the government not to make us homeless, but it did the opposite. Our children also protested on Sunday and urged the supreme court to stop demolition. It seems no one here cares for the future of the poor.”
At least 8,000 houses are being knocked down along the nullahs. The work, which began in February, is in response to the 2020 Karachi floods that saw choked up nullahs overflow and swamp the city. Improvements to Karachi’s water and sewage systems are being financed by the World Bank.
As people watched their homes being turned into rubble, civil society organisations approached the court to try to stop the evictions. They said the houses were not to blame for blocking the waterways.
But on Monday the supreme court rejected the petition.
While dozens of people told the Guardian they were renting their homes, the court said any leasing of land along the nullahs was illegal. Activists and writers have termed the decision “unjust”. Writer Fatima Bhutto, of the Bhutto political dynasty, tweeted: “The supreme court’s decision is a tragedy.”
In an editorial, Pakistan’s largest English-language daily, Dawn, said: “The demolition of houses situated within nine metres on either side of the Gujjar and Orangi nullahs will continue. When this exercise is completed (before this year’s monsoon, according to the plan), at least 100,000 people would perhaps have been rendered homeless. As many as 21,000 children would be out of school and living under the open sky.”
Bibi’s house was her family’s home for five decades. She shared it with four daughters and three sons-in-law. “We all started living on the lawn after they demolished our house but they will snatch the lawn now. At first, they took our shelter, now they will take our land,” she says.
Muhammad Shahid is a heart patient whose house was bulldozed a month ago. He expected justice from the court.He was at home when his house was bulldozed at around 11am one morning.
“We are helpless. Where should we go? We can’t die or live. I had my angiography done and now I can’t work. My children aren’t educated enough. My wife had a paralysis attack,” says Shahid. He says that even he has not got the 90,000 Pakistani rupees (£410) promised by the government.
Muhammad Aslam did receive some compensation for the loss of his house. But he says it is not enough. He says: “I want to return the amount because it is of no use for four families.” He lives with 28 others in one room and a tent after his two-storey house was bulldozed. “We are troubled in all ways, there is no gas or electricity or even sanitation. This isn’t living,” says Aslam.
Architect and urban planner Arif Hasan says the government had no “proper plan”. “They are not doing it merely to stop the flood but to make long roads along the nullahsconnecting the Lyari expressway with the northern bypass, displace poor and benefit the rich.” He says the World Bank should denounce the Sindh government, as forced evictions are against the bank’s policies.
Muhammad Abid Asghar was one of the first to lose his home, on 2 February. With others, he established Gujjar Nala victims committee and, with activists of Karachi Bachao Tehreek (Save Karachi Movement), went to the Sindh high court.
After chalking slogans against the demolitions on walls around the city, the activists say they were called by the World Bank team for a meeting in April.
“We had believed the bank was funding the evictions, but the World Bank denied it. They assured us that no leased houses would be bulldozed.”
Sindh minister for information, Nasir Hussain Shah, also says the World Bank is not linked to the evictions. “The government will help residents in rehabilitation,” he says, adding that “not more than 5%” of residents were against the demolition works.
The World Bank did not respond to a request for comment.
The Chinese mission to the EU denounced a Nato statement that declared Beijing a “security challenge,” saying China is actually a force for peace but will defend itself if threatened, AP reports. The Chinese news release said the Nato statement was a “slander on China’s peaceful development, a misjudgment of the international situation and (Nato’s) own role, and a continuation of the Cold War mentality and organisational political psychology.”
The United Kingdom left the European Union on 31 January 2020. The EU settlement scheme was designed to offer EU, non-EU EEA, and Swiss citizens and their eligible family members, living in the UK, an opportunity before the end of the transition period to protect their ability to reside in the UK.
A new report has warned that hundreds of thousands of European Union (EU) and European Economic Area (EEA) nationals and their children in the UK are in danger of finding themselves in a post-Brexit legal limbo on 1 July.
The academic campaign group UK in a Changing Europe highlights the fact that unless these citizens meet the government deadline and apply by 30 June for settled or pre-settled status, ahead of the curtailment of the EU Settled Status scheme, their work, rent and retirement rights are at risk.
“If applicants cannot demonstrate they have a ‘right to reside’, they will lose their rights immediately, even if their application is valid. This is likely to impact most severely upon vulnerable applicants with complicated cases. Given delays in processing applications this difference in treatment could become quite significant,” warns the report.
The EU Settled Status scheme grants European Union nationals (as well as those from Norway, Iceland, Liechtenstein and Switzerland) and some family members to apply for ‘settled status’ or, if they have less than five years residence, ‘pre-settled status’.
Alarms have been sounded in “The EU Settlement Scheme” report that while some people have already applied, they are still awaiting a decision from the Home Office.
If they miss the deadline, they may be unable to prove their status when trying to access National Health Service (NHS) services, or travelling.
320,000 people, according to official statistics, are still awaiting a decision on their ‘status – settled status’. The government has been trying to offer reassurances, saying that those on the waiting list do not need to worry. A “pragmatic and flexible approach” was vowed regarding late applications.
However, Catherine Barnard, deputy director of UK in a Changing Europe and a professor in EU law at Cambridge University, urges people to take stock of the legal implications.
“In order to apply for settled or pre-settled status all you needed to be was resident in the country before 31 December. But in order to be protected after 30 June, if you have not got the status, you have to be exercising EU treaty rights which means you have to be in work, self-employed, a student or a person of independent means,” she was quoted as saying.
Difficulties could be in store for children, the retired or spouses of an EU citizen who are from a non-EU country who have applied for but have not been granted status, underscored Barnard. Furthermore, older adults who have resided in the country for decades and did not believe they needed to apply for citizenship could be at risk.
An analysis by UK in a Changing Europe revealed that only 2% of the 5.4 million applications for status fall into the over-65 category. While hailing the success of the EU settled status, Barnard said:
“…It is about to enter a phase that will require sensitive management where the government will need to show pragmatism and flexibility in dealing with difficult cases.”
The UK left the EU on 31 January 2020 under a negotiated deal – the EU-UK Withdrawal Agreement – that provided for an extension of all EU law until 31 December 2020.
On that date, EU free movement law in the UK ended, with the Withdrawal Agreement offering a ‘buffer’ to prevent EU, EEA or Swiss citizens finding themselves stripped of EU free movement law rights and without any other lawful residence status on 1 January 2021.
A grace period of 6 additional months was allowed for European citizens and their family members to protect their lawful UK residence status via the EU Settlement Scheme (EUSS).