đ In Lebanon, refugees bloom; The WHO says immigrants need room; For coffee, it might just be doom
#599 | A week for acronyms; A week for deferred votes and deals; Not a week for refugees
Hello, and welcome back to The Kable. A brand new month it may well be but as the famous serial killer Stephen King once wrote, SSDD.
Something new did happen this week, though. Humanity planned a trip back to the moon for the first time in over five decades, but weâre still no closer to sending Space Karen on a one-way shuttle to Mars.
In Africa, the Africa CDC is getting back into the acronyms game and making up for lost time with a mouthful this time. Spark-NCDs, or to fully spell it out, Strengthening Public Health Surveillance and Resilient Knowledge for Non-Communicable Diseases in Africa. Launched in Tanzania early in the week, this program, yet another flagship one, will enhance disease surveillance systems, generate comprehensive NCD data, develop healthcare workforce capacity, and implement integrated, people-centred care across the continent. If it works as intended, we will forgive the mealy-mouthedness of the name.
Speaking of acronyms, how about BRIGHT then? Thatâs what the International Vaccine Institute (IVI) and the Brazilian government have named their joint fund, looking to boost research in Global South health innovation. In case youâre wondering, BRIGHT as in Bridging Research Investment in Global Health Technology.
Talking about Global South cooperation, one bit of news that we missed, and one that thankfully isnât an acronym, is the announcement by FIOCRUZ about the launch of the Global Coalition for Local and Regional Production, Innovation and Equitable Access. HQ-ed in Brazil, this, umm, coalition, will work on vaccines, therapeutics, diagnostics, and health technologies. And it has a bucketload of partners on board already.
There will be a couple of mentions of Sudan in todayâs Kable. And with good reason. The country has the worldâs largest population of internally displaced people only because the land is rich in agriculture, livestock, mineral, and gold resources, which certain states in other parts of the world are looking to corner. In a teeny-tiny bit of good news, the Global Fund has approved emergency TB funding to support diagnosis and treatment for displaced people and host communities. A small amount - a little over $1.5 million - but the Fund is hoping this will cover 10 states that are less conflict-ridden.
The Pandemic Agreement that we wrote about so eloquently last week (pat, pat)... well, the delegates debating the agreement didnât close it out. Instead, they agreed to negotiate for five more days from April 27 to May 1.
If you looked at the Pasteur Instituteâs network website for a list of their members across the world, you will see 32 members, with 7 in Africa and 9 in Asia. One of the 9 in Asia is Tehranâs institute, set up in 1920, which also serves as a biobank and cell bank and stores malaria vectors and has BSL-2 and BSL-3 labs where research on arboviruses and AIDS and TB and hepatitis and other conditions happens. Thanks to Israel and the US, though, now there are only 8 Pasteur Institutes in Asia. Well, itâs okay. Pasteurisation is overrated anyway. Ask the US. Raw milk is all the rage there. Raw milk and E.coli.
We couldnât resist this. Sorry. The Medicines for Malaria Venture is taking AIm at malaria in a partnership with deepmirror, with the launch of Drug Design for Global Health (dd4gh) (yeah, yeah another acronym, we dgaf). dd4gh (canât even key that in without making typos) is an AI platform that will speed up drug discovery for researchers working on new malaria drugs. Hopefully, faster than those blasted mosquitoes can adapt.
Elsewhere, the Pandemic Fund has announced its fourth call for proposals with a new targeted approach. Instead of open competition, this round focuses on 15 countries facing the highest pandemic risks and capacity needs that have never received multilateral country grants: Afghanistan, Benin, the Central African Republic, the Republic of Congo, Eritrea, Guinea, Haiti, Liberia, Madagascar, Mali, Mozambique, Niger, Nigeria, Sudan, and Uganda. With $244 million total available, each country receives a preset allocation or maximum request amount, plus a full year to develop proposals.
The MSF has written an open letter to Gilead, once again asking Gilead to sell them their HIV drug Lenacapavir, instead of asking them to only wait for Global Fund supplies. Once again, Gilead has said no. Not because they canât give. But because they wonât. Even a cursory look at Gileadâs history wouldâve been enough for MSF to know that doing the right thing isnât what Gilead is about.
A timely study in The Lancet Neurology that says 2023 saw more than 250,000 people die of meningitis. Somebody send this to health authorities in the UK and to whoever is in charge of the meningitis page at the WHO. Donât bother sending it to health authorities in the US, though, because there are no health authorities there anymore. âMurrrica.
In Hong Kong, online retailer HKTVmallâs parent company, Hong Kong Technology Venture Company, released its annual report. And in the report was this: âThe team is dedicated to developing and refining equipment designed to maintain the viability of detached body organs, such as limbs and heads. The team has conducted 38 experiments in which the animalsâ limbs or heads were separated from their bodies.â Yup, there was blowback. And the company issued a clarification saying the only animals involved were pigs and sheep. Glad thatâs all sorted then.
The WFP this week issued a statement that âglobal disruptions to supply chainsâ are why people will be hungry tomorrow. The âglobal disruptions to supply chainsâ is the âclosureâ of the Strait of Hormuz to forces hostile to the territory that governs said Strait.
And the UN Security Council this week actually voted, on a resolution brought by Bahrain, to authorise armed force to open the Strait of Hormuz. None of the speakers at the Council said anything about Iran being attacked, but had lots to say about Iran doing the attacking. The US even spoke at the Council, and the only representative who even mentioned Israel was Pakistan. After the first vote failed, thanks to a veto by Russia, China, and France, Bahrain re-drafted the resolution to make it defensive intervention. The Security Council was scheduled to vote again today, but it has been deferred to next week.
Moving on to our favourite subject: disease. Taiwan has reported its first case of human bird flu and 33 close contacts have been identified already. Singapore has reported its first local case of the new mpox strain. And in Germany, the mpox clade 1b strain is quietly becoming a clusterrhymeswithbuck. In the US though, the CDC is on top of things. The agency has paused or stopped testing for dozens of infectious diseases. Testing is so third-world, baby! In India, in Etah in Uttar Pradesh, a mystery viral fever is once again raging. This seems to happen in this same place like clockwork every 4 to 5 months.
We wonât even tell you about the theft of viral samples from a BSL-3 lab in Brazil, some of which were later found discarded in a public trash bin. Some of the known samples included H1N1 and H3N2 flu viruses - both human and swine variants, and the rest are still being tested. And here, weâre thinking BSL-3 facilities are all super-secure.
Apropos of nothing, we recently discovered there is an association in India that works towards dissemination of awareness about heart strokes, and also research on the subject. Unfortunately, theyâve named themselves Indian Stroke Association. And their website is... umm, take a look.
And finally, groundbreaking scanning technology has revealed a mysterious structure hidden beneath ancient city ruins in Egyptâs northwest Nile Delta. No news yet on whether they found an ancient book with it, but we know what happens next.
Stories Of The Week
No safe country for women. In war and conflict, the first group of people to pay the price are always children and women. And theyâre also the ones who pay the price for the longest time. We hear about soldiers, mostly men, who went to war and got PTSD and had movies made about them, but never about the children and women who became victims of conflict they didnât seek or make. However, weâve all seen news and reports of what happens to children and women. Child soldiers beaten and abused into soldiering, women abused, sold, traded across war zones around the world. Horrifying testimony after testimony about abuse of the worst kind. And it never ends. (Disclaimer: we arenât including transpeople here simply because of lack of data and no other reason)
This time, it is from Sudan via a new report from MSF. Between January 2024 and November 2025, at least 3,396 victims and survivors of sexual violence sought treatment in MSF-supported facilities across North and South Darfur, though MSF warns this represents only a fraction of the true scale, as many cannot safely reach care. Women and girls accounted for 97% of victims treated in MSF programmes. Following the RSFâs capture of El Fasher, the capital of North Darfur, on 26 October 2025, MSF treated more than 140 victims who reached Tawila in November, with 94% of these attacked by armed men along escape routes. In just one month between December 2025 and January 2026, MSF identified a further 732 victims in displacement camps around Tawila, where women reported attacks both during their journeys and within the camps.
The violence extends far beyond active conflict zones. In South Darfur, hundreds of kilometres from active ground fighting, 34% of victims were assaulted while farming or travelling to farmland, and 22% while collecting firewood, water or food. Children are also among the victims, with one in five survivors in South Darfur under 18 years of age, including 41 children younger than five.
MSF data shows patterns of systematic abuse, with armed men responsible for most assaults - over 95% in North Darfur, while nearly 60% in South Darfur involved multiple perpetrators. Survivors face significant barriers to care including insecurity, stigma and limited protection services, while sexual violence is being used as a weapon of war and a systematic means of controlling civilians, in violation of international humanitarian law.
(MSF)
Immigrants, they get the job done. Increasingly around the world, weâre becoming more insular as people. Insular to the point of xenophobic, even. Not just among countries but even within countries. Within states, even. And this insularity is coming at a time when increasingly people are migrating because opportunities are condensing into ever-smaller pockets around the world. Every sociological survey for the longest time has been saying that we will be a planet of migrants and refugees in no time at all, thanks to conflict, climate, cash, and commerce. Yet, the words migrants and refugees invoke derision more than shared empathy no matter where you go. Is there hope around the corner though?
More than 60 countries now include refugees and migrants in their national health policies, according to a new WHO report tracking progress on 2019 World Health Assembly commitments. The survey of 93 member states finds two-thirds include these populations in health plans, with 16 countries reporting refugees can access services on par with host populations, 14 extending that to documented migrant workers, and 11 to asylum seekers.
However, no country surveyed provides equal access to migrants in irregular situations - those living without legal status or documentation. While Belgium and Chile are presented as positive examples with intercultural mediation programs and migrant community representatives in health councils, the report reveals significant gaps: only 37% of countries routinely collect migration-related health data, fewer than 40% train health workers in culturally responsive care, and just 30% run campaigns to counter discrimination.
The situation is particularly dire in emergency planning, with only 42% of countries including refugees and migrants in disaster risk reduction frameworks, and irregular migrants entirely absent from those plans. Oh and, wealthy nations? Theyâre actively restricting access. Not even talking about openly xenophobic places like the US. Canada plans to start charging refugees for essential services in May. Germany extended emergency-only care restrictions to 36 months because when you come to a new land with no resources and no support and no people, three years is all the time you need to stand entirely on your feet.
(WHO)
Exodus in motion. If you want to look at how refugees are made, there is a refugee crisis unfolding in real-time right now in Lebanon, thanks to those decades-old experts in dispossessing and displacing people. More than one in every five children in Lebanon has been forced to flee their homes in just one month, as Israeli airstrikes and displacement orders have displaced 1.2 million people - 20% of the population - since early March, including 350,000 children. Families are forced to leave everything behind, with many relying wholly on humanitarian aid after years and years of living in crisis mode already. If that wasnât proof enough, here UNICEF is piling it on, saying that in just three weeks, 370,000 children have been forced out of their homes at an average of at least 19,000 children displaced every single day. The UNâs top humanitarian official told the Security Council that Lebanon is facing one of its most dangerous moments in years, with over 1,240 people killed and 3,500 injured in the past four weeks. The situation is particularly dire in Syria, where UNHCR reports more than 200,000 people have crossed the border from Lebanon since March 2, with the vast majority being Syrian refugees who had fled Syria previously and are now forced to flee again. The IOM has called for increased international support, saying the scale of displacement is pushing the country to its limits. With only $94 million received of a $308 million emergency appeal, humanitarian agencies are struggling to meet needs as displaced families crowd into 660 collective shelters - including 470 schools turned into temporary housing - with many sleeping on streets or sharing classrooms without privacy, heating, or adequate hygiene. Even places - historical and cultural monuments - are under threat, with UNESCO taking 39 of them under its protective wing. Like that will stop Israel.
(Save The Children, UNICEF, UN, UN, IOM, UNESCO)
Donât forget Somalia either. Nearly 2 million children across Somalia are at risk of acute malnutrition as the country faces a deepening emergency driven by drought and the same old combo of conflict, displacement and funding cuts. The attack on Iran and the subsequent stress on global supply chains, with transport costs for food, medicines, fuel and water becoming more expensive, is only making things worse.
With Somaliaâs heavy reliance on imports, prices are climbing fast. In drought-affected areas, water costs have more than doubled as scarcity grows and fuel for delivery becomes unaffordable. UNICEF has $15.7 million worth of supplies in transit for Somalia, including nutritional treatments, vaccines and insecticide-treated bednets, but these shipments risk delays or added costs if the situation in Iran remains unresolved. Over the past year, more than 400 health and nutrition facilities have already shut down due to insufficient financing, including 125 sites offering vital nutrition assistance. Without immediate support, more may be forced to shut down in districts experiencing the highest levels of food and nutrition insecurity. And worsening drought could push 6.5 million Somalis into crisis and emergency levels of food insecurity by the end of this month. What UNICEF needs is $121 million for this year and what theyâve raised so far is less than $20 million.
(UNICEF)
Huff and puff and turn yourself around. A large study finds that just a few minutes of vigorous physical activity each day could dramatically cut your risk of major diseases, including a 63% lower risk of dementia, 60% lower risk of type 2 diabetes, and 46% lower risk of death. The research, published in the European Heart Journal, shows itâs not just how much you move, but how intensely you move that matters, with short bursts of vigorous activity like rushing for a bus or climbing stairs quickly linked to striking reductions in disease risk. The study even found that intensity played a larger role for certain diseases. For inflammatory conditions like arthritis and psoriasis, intensity was the key factor, while for diabetes and liver disease, both duration and intensity mattered. Now, if only jumping to conclusions was considered vigorous activity, weâd be in peak physical form right now.
(European Heart Journal)
Breakthroughs
Go to bed whenever but wake up early as heck! A new clinical trial found that solriamfetol can significantly boost alertness in early morning shift workers struggling with shift work disorder. The study included 78 workers who typically start shifts between 3 AM and 7 AM - a time when the brain is biologically programmed to sleep. Participants taking the drug showed clear improvements, staying less sleepy and remaining awake longer during simulated work hours, with both participants and clinicians noting better overall functioning, improved work performance, and greater ability to manage daily tasks throughout full eight-hour shifts. The research addresses a major gap in shift work disorder treatment, as previous medications have mainly been studied in overnight workers and can interfere with later sleep. This drug, though promotes alertness for extended periods without significantly disrupting later rest. The study has only been funded by two pharma companies, so itâs highly unlikely if the trial resulted in market approvals, it would be sold to your corporate overlords to get you to come in to work early. Nope. Nor will it be given to you as a bonus.
(NEJM Evidence)
Bottom line
Is it hot or is it just us? If youâre talking rural Africa, then itâs definitely not us. Not that we arenât hot. But rural Africa is hotter. And getting even more so. A new study using 10 global climate models reveals that rural African communities are facing dangerous heatwave exposure nearly twice as much as urban residents, and the heat gap is growing. While everyone assumes cities trap heat the worst, the research shows rural populations across Africa are already recording between 20 and 1,000 person-days of heatwave exposure per year, compared to urban residentsâ fewer than 20 person-days. Under a future with meaningful emissions action, rural exposure in south-east Africa will reach over 200 million person-days by centuryâs end, versus roughly 100 million for urban dwellers. In high-emission scenarios, climate change becomes the dominant force, driving rural heatwave exposure to roughly 70 million person-days in south and west Africa combined, compared to just 5 million for urban populations. The danger isnât just how hot it gets but how hot it gets in places with no way to escape it, where farmers canât stop working when temperatures spike and pregnant women face heat exposure linked to premature births with no nearby clinics to intervene.
(The Conversation)
Bug free and fantastic. Who even likes insects, right? Sure, there will be the odd, quirky nephew here and there who is an avid insectologist or whatever but people in general prefer seeing as little as possible of them as they can. Thankfully, climate change may make it so that we donât have to see them at all. At least some to begin with. A new study measuring heat tolerance of over 2,000 insect species in Kenya and Peru reveals that many tropical insects are already living close to their thermal limits and may struggle to survive further warming. The research shows that insects from lowland areas are already very close to their critical thermal maximum - the temperature at which they lose motor control due to heat stress - while flies are particularly vulnerable with lower tolerance and less stable proteins. The study used mountains as natural laboratories, collecting insects from hot lowland savannas to cooler highland forests and gradually increasing temperature until each insect entered heat coma. Results showed that lowland insects have little to no capacity to temporarily increase heat tolerance through physiological responses like producing heat shock proteins, while insects from higher elevations could slightly adjust to more heat. This suggests heat limits may be constrained by fundamental protein architecture, meaning many species may not be able to evolve fast enough to keep pace with rapid climate change. Study authors posit that with insects making up 90% of all animal species and being essential to ecosystems through pollination, waste recycling, and forming food webs, the loss of tropical insect species would have far-reaching consequences for ecosystems, agriculture and human well-being. Pollination, smollination! Bah! Itâs not like weâll even have oxygen to breathe. What is with all this pollination nonsense? Kill the butterflies and kill the bees too. We donât need honey, weâll have whiskey. Hic!
(The Conversation)
Who drank all the coffee? Weâve only been sharing good news on the coffee front for a long time now. Finally, the law of averages has caught up with our favourite brew. A new Rabobank report reveals that climate change could make 20% of land currently used to grow arabica coffee unsuitable by 2050, more than double the share already considered unsuitable. While Ethiopia gets the lucky break, with highly suitable areas nearly tripling from 4% to 13% of current production, Honduras faces the sharpest decline, with suitable growing areas shrinking from 53% to just 12% of current production land. Brazil, the worldâs largest producer, would see its suitable areas drop from 81% to 62%, while Colombiaâs unsuitable zones could rise from 7% to 18%. The coming decade is critical for the entire coffee value chain as companies will need to shift from reactive planning to forward-thinking strategies, investing in climate-smart practices and building long-term partnerships in emerging regions. Of course, this all assumes that by 2050, humanity will still be around to worry about coffee rather than something more pressing, like where to find clean water or avoid the latest heat-induced apocalypse. But if there isnât coffee, there better be an apocalypse.
(Rabobank)
Long reads
A haunting eternal. Mosquitoes are back, like a spectre to haunt these pages, this time via The Conversation, talking about how malaria-carrying mosquitoes evolve faster than insecticides that can kill them. Because of course they do.
(The Conversation)
Drop in the ocean. About the Gilead-MSF story earlier, this piece in The Guardian of all places highlights why it is important that Gilead stop choking the supply of this drug. But hey, whereâs the money in that?
(The Guardian)
Oooh, conundrum! Dunno whatâs up with Gavi, but theyâve been on a roll with content on their VaccinesWork page lately. This piece dissects whether it is vaccination or infection that is more likely to cause an autoimmune condition. Hint: the answer doesnât begin with v.
(Gavi)
Oh, and Gopal Nair doesnât want you to see this.