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    The Unnecessary Suffering of Women With Obstetric Fistulas

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    One of the most dangerous things a woman can do in much of the world is become pregnant, and the risks caught up with a Kenyan named Alice Wanjiru a decade ago.Then 20 years old and pregnant for the first time, she suffered a childbirth injury called an obstetric fistula, caused by prolonged labor without access to a C-section to end it. This left her with a hole in the tissue between her rectum and her vagina, and for 10 years she endured the humiliation of continually leaking stool through her genital tract.“I could never get fully clean, for there was always some stool left,” she told me. “The other women would say, ‘She is the woman who stinks.’ I would ask God, ‘Why me? Why can’t I be like other women?’”Wanjiru bathed herself several times a day, fasted from morning until evening so there wouldn’t be much in her digestive tract during the day, and always wore a sanitary pad. Doctors misdiagnosed her, sex was a nightmare and her husband abandoned her after harshly accusing her of having poor hygiene.Shamed by the continuous odor, she withdrew from friends and stayed home from church and other gatherings. She endured her shame in solitude, year after year.Perhaps one million or two million women worldwide are enduring fistulas and leak stool or, more commonly, urine through their vaginas. These are typically impoverished women in poor countries where home births are the norm, who couldn’t get to a doctor in time for a needed C-section.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      World Bank Warns of Record Debt Costs for Developing Countries

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      The World Bank warned in a new report that poor countries will be stuck in economic “purgatory” without debt relief.Soaring inflation saddled developing countries with a record $1.4 trillion in debt servicing costs last year, the World Bank said in a report published on Tuesday, detailing the precarious state faced by the world’s most vulnerable economies since the pandemic.As central banks around the world raised interest rates to slow rising prices, poor countries with already high debt burdens saw the interest payments on the money that they owed to creditors balloon. While principal balances held steady at around $951 billion, interest payments jumped by a third, to $406 billion. That has left more countries facing fiscal crises and struggling to avoid default.“These facts imply a metastasizing solvency crisis that continues to be misdiagnosed as a liquidity problem in many of the poorest countries,” Indermit Gill, the World Bank’s chief economist, wrote in the report. “It is easy to kick the can down the road, to provide these countries just enough financing to help them meet their immediate repayment obligations. But that simply extends their purgatory.”More than a dozen sovereign nations defaulted on their debt in the last three years, and more than 30 of the world’s poorest countries have experienced “debt distress,” according to the United Nations. In 2023, Belarus, Ghana, Lebanon, Sri Lanka and Zambia were all in default, according to Fitch Ratings.Global financial institutions such as the World Bank and the International Monetary Fund have been working with international lenders to help developing countries restructure their debt, but the process has been slow and painstaking. China, the world’s largest creditor, has been particularly reluctant to alter the terms of its loans as it grapples with its own economic challenges.The Biden administration has been critical of China’s lending practices. Treasury Secretary Janet L. Yellen described them as “opaque” in an interview with The New York Times in October in which she called for accelerating debt relief. She also raised the idea of helping nations find new sources of borrowing by creating coordinated aid packages for “high-ambition countries” that want to invest in clean energy projects.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      COP29 Climate Talks Get a Deal on Money, but Only After a Fight

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      The financing plan, which calls for $300 billion per year in support for developing nations, was immediately assailed as inadequate by a string of delegates.Negotiators at this year’s United Nations climate summit struck an agreement early on Sunday in Baku, Azerbaijan, to triple the flow of money to help developing countries adopt cleaner energy and cope with the effects of climate change. Under the deal, wealthy nations pledged to reach $300 billion per year in support by 2035, up from a current target of $100 billion.Independent experts, however, have placed the needs of developing countries much higher, at $1.3 trillion per year. That is the amount they say must be invested in the energy transitions of lower-income countries, in addition to what those countries already spend, to keep the planet’s average temperature rise under 1.5 degrees Celsius. Beyond that threshold, scientists say, global warming will become more dangerous and harder to reverse.The deal struck at the annual U.N.-sponsored climate talks calls on private companies and international lenders like the World Bank to cover the hundreds of billions in the shortfall. That was seen by some as a kind of escape clause for rich countries.As soon as the Azerbaijani hosts banged the gavel and declared the deal done, Chandni Raina, the representative from India, the world’s most populous country, tore into them, saying the process had been “stage managed.”“It is a paltry sum,” Ms. Raina said. “I am sorry to say that we cannot accept it. We seek a much higher ambition from developed countries.” She called the agreement “nothing more than an optical illusion.”Speakers from one developing country after another, from Bolivia to Nigeria to Fiji, echoed Ms. Raina’s remarks and assailed the document in furious statements.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      COP29 Climate Talks in Baku, Azerbaijan, Head Into Final Stretch

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      Senior ministers are arriving in an effort to break a deadlock over the summit’s main goal: funding to help lower-income countries hit hard by global warming.More than halfway through the United Nations climate talks in Baku, Azerbaijan, negotiators from nearly 200 countries remain far apart on a number of the key issues up for debate.As nations try to agree on a plan to provide potentially trillions of dollars to developing countries suffering from the effects of climate change, divisions remain over how much money should be made available, what kind of financing efforts should count toward the overall goal and how recipient countries should gain access to the funds.Negotiations often go into overtime. But with just four days to go, many attendees fear that this could be the first summit since the Copenhagen talks in 2009 to conclude without a deal.“There is a high risk this could collapse,” said a senior negotiator for a major European country, who requested anonymity because they were not authorized to speak publicly.Simon Stiell, the United Nations climate chief, pleaded on Monday with countries to stop fighting and to reach a deal.He warned against a dynamic “where groups of parties dig in and refuse to move on one issue, until others move elsewhere.” He added, “This is a recipe for going literally nowhere.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A Loss and Damage Fund Is Taking Shape at COP Climate Talks

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      The U.N. climate summit in Azerbaijan has cleared the for way aid to flow when lower-income countries are hit.A long-awaited fund designed to help lower-income countries respond to natural disasters is finally taking shape at the U.N. climate conference in Baku, Azerbaijan.Wealthy nations agreed to create the fund at the 2022 climate summit in Sharm el Sheikh, Egypt, after decades of resistance. Last year, a group of nations, including the United States and the European Union, made the first financial commitments.Now, the fund has a leader and is looking to start distributing money within the next year.Ibrahima Cheikh Diong, who has Senegalese and American citizenship and has held roles at financial firms and at development banks, started this month as the inaugural executive director of the initiative, which is formally known as the Fund for Responding to Loss and Damage.At this year’s climate summit, known as COP29, formal agreements were signed that will allow the fund to begin formally receiving the money that has been pledged and to start distributing it soon. The fund is being managed by the United Nations, and the World Bank is serving as a financial trustee.Sweden this month became the latest country to make a pledge, with its $19 million contribution bringing total commitments to around $720 million.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Nuclear Power Was Once Shunned at Climate Talks. Now, It’s a Rising Star.

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      Growing worldwide energy demand and other factors have shifted the calculus, but hurdles still lie ahead.For years at global climate summits, nuclear energy was seen by many as part of the problem, not part of the solution.Sama Bilbao y Leon has been attending the annual United Nations climate change talks since 1999, when she was a student of nuclear engineering. And for most of that time, she said, people didn’t want to discuss nuclear power at all.“We had antinuclear groups saying, ‘What are you doing here? Leave!’” she said.These days, it’s a very different story.At last year’s climate conference in the United Arab Emirates, 22 countries pledged, for the first time, to triple the world’s use of nuclear power by midcentury to help curb global warming. At this year’s summit in Azerbaijan, six more countries signed the pledge.“It’s a whole different dynamic today,” said Dr. Bilbao y Leon, who now leads the World Nuclear Association, an industry trade group. “A lot more people are open to talking about nuclear power as a solution.”The list of countries pledging to build new nuclear reactors, which can generate electricity without emitting any planet-warming greenhouse gases, includes longtime users of the technology like Canada, France, South Korea and the United States. But it also includes countries that don’t currently have any nuclear capacity, like Kenya, Mongolia and Nigeria.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      What to Know About the BRICS Summit and the Countries Involved

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      The group, which seeks to rebalance the global order away from the West, will meet on Tuesday. Here’s a primer.Leaders of BRICS, a group of emerging market nations that represent about half of the world’s population, will meet for a high-profile summit on Tuesday, their first since a major expansion last year.BRICS stands for Brazil, Russia, India, China and South Africa. This year, the group has expanded to include Egypt, Ethiopia, Iran and the United Arab Emirates. The members will gather for the three-day conference in Kazan, a city in southwest Russia.The summit comes at a high-profile moment for BRICS, which sees itself as a counterweight to the West. World leaders will stand side-by-side with President Vladimir V. Putin of Russia, despite his pariah status in the West.But there are deep differences between member states, and the bloc has struggled to articulate and define its purpose.Here’s what you need to know:What is BRICS?What holds the group together?What does the Global East want?What about the ‘Global South’?What does China want?Barbara Berasi for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Fears of a Global Oil Shock if the Mideast Crisis Intensifies

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      The threat of an escalating conflict between Israel and Iran has created an “extraordinarily precarious” global situation, sowing alarm about the potential economic fallout.As the world absorbs the prospect of an escalating conflict in the Middle East, the potential economic fallout is sowing increasing alarm. The worst fears center on a broadly debilitating development: a shock to the global oil supply.Such a result, actively contemplated in world capitals, could yield surging prices for gasoline, fuel and other products made with petroleum like plastics, chemicals and fertilizer. It could discourage investment, hiring, and business expansion, threatening many economies — particularly in Europe — with the risk of recession. The effects would be potent in nations that depend on imported oil, especially poor countries in Africa.The possibility of this calamitous outcome has come into focus in recent days as Israel plots its response to the barrage of missiles that Iran unleashed last week. Some scenarios are seen as highly unlikely, yet still conceivable: An Israeli strike on Iranian oil installations might prompt Iran to target refineries in Saudi Arabia or the United Arab Emirates, both major oil producers. Iranian-supported Houthi rebels claimed credit for an attack on Saudi oil installations in 2019. The Trump administration subsequently pinned the blame on Iranian forces.As it has done before, Iran might also threaten the passage of tankers through the Strait of Hormuz, the critical waterway that is the conduit for oil produced in the Persian Gulf, the source of nearly one-third of the world’s oil production. Such a move could entail conflict with American naval ships stationed in the region.That, too, is currently considered to be improbable. But the upheaval in the region in recent months has pushed out the parameters of possibility, rendering imaginable scenarios that were once dismissed as extreme.As Israel plots its next move, it has other targets besides Iranian oil installations. Iran would have reason for caution in crafting its own retaliation. Broadening the war to its Persian Gulf neighbors would invite a punishing response that could push Iran’s own economy — already bleak — to the brink of collapse.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Gilead Agrees to Allow Generic Version of Groundbreaking H.I.V. Shot in Poor Countries

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      Many middle-income countries are left out of the deal, widening a gulf in access to critical medicines.The drugmaker Gilead Sciences on Wednesday announced a plan to allow six generic pharmaceutical companies in Asia and North Africa to make and sell at a lower price its groundbreaking drug lenacapavir, a twice-yearly injection that provides near-total protection from infection with H.I.V.Those companies will be permitted to sell the drug in 120 countries, including all the countries with the highest rates of H.I.V., which are in sub-Saharan Africa. Gilead will not charge the generic drugmakers for the licenses.Gilead says the deal, made just weeks after clinical trial results showed how well the drug works, will provide rapid and broad access to a medication that has the potential to end the decades-long H.I.V. pandemic.But the deal leaves out most middle- and high-income countries — including Brazil, Colombia, Mexico, China and Russia — that together account for about 20 percent of new H.I.V. infections. Gilead will sell its version of the drug in those countries at higher prices. The omission reflects a widening gulf in health care access that is increasingly isolating the people in the middle.Gilead charges $42,250 per patient per year for lenacapavir in the United States, where it is approved as a treatment for H.I.V. The company has said nothing about what lenacapavir will cost when used to prevent H.I.V. infections, a process called pre-exposure prophylaxis, or PrEP.The generics makers — four companies in India, one in Pakistan and one in Egypt — are expected to sell it for much less. Researchers at Liverpool University found the drug could profitably be produced for as little as $40 per patient per year, if it were being purchased in large volumes.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More