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Phoenix — Alfred Handley leaned back in his wheelchair alongside a major Phoenix freeway as a street medicine team helped him get rehydrated with an intravenous saline solution dripping from a bag hanging on a pole.

Cars whooshed by under the blazing 96-degree morning sun as the 59-year-old homeless man with a nearly toothless smile got the help he needed through a new program run by the nonprofit Circle the City.  

“It’s a lot better than going to the hospital,” Handley said of the team that provides health care to homeless people. He’s been treated poorly at traditional clinics and hospitals, he said, more than six years after being struck by a car while he sat on a wall, leaving him in a wheelchair.

Circle the City introduced its IV rehydration program as a way to protect homeless people from life-threatening heat illness as temperatures regularly hit the triple-digits in America’s hottest metro. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Maricopa County, which encompasses metro Phoenix.

Dr. Liz Frye, vice chair of the Street Medicine Institute that provides training to hundreds of health care teams worldwide, said she didn’t know of groups other than Circle the City administering IVs on the street.

“But if that’s what needs to happen to keep somebody from dying, I’m all about it,” Frye said.

As summers grow warmer, health providers from San Diego to New York are being challenged to better protect homeless patients.

Even the Boston Health Care for the Homeless Program, featured in last year’s book, “Rough Sleepers,” now sees patients with mild heat exhaustion in the summer after decades of treating people with frostbite and hypothermia during the winter, said Dr. Dave Munson, the street team’s medical director.

“It’s certainly something to worry about,” said Munson, noting that temperatures in Boston hit 100 degrees with 70% humidity during June’s heat wave. Homeless people, he said, are vulnerable to very hot and very cold weather not only because they live outside, but they often can’t regulate body temperature due to medication for mental illness or high blood pressure, or because of street substance use.

The Phoenix team searches for patients in homeless encampments in dry riverbeds, sweltering alleys and along the canals that bring water to the Phoenix area. About 15% are dehydrated enough for a saline drip.  

“We go out every day and find them,” said nurse practitioner Perla Puebla. “We do their wound care, medication refills for diabetes, antibiotics, high blood pressure.”

Puebla’s street team ran across Handley and 36-year-old Phoenix native Phillip Enriquez near an overpass in an area frequented by homeless people because it’s near a facility offering free meals. Across the road was an encampment of tents and lean-tos along a chain-link fence.  

Enriquez sat on a patch of dirt as Puebla started a drip for him. She also gave him a prescription for antibiotics and a referral to a dentist for his dental infection.

Living outside in Arizona’s broiling sun is hard, especially for people who may be mentally ill or use sedating drugs like fentanyl that make them less aware of surroundings. Stimulants like methamphetamine contribute to dehydration, which can be fatal.

Temperatures this year have reached 115 degrees (45 Celsius) in metro Phoenix, where six heat-related deaths have been confirmed through June 22. Another 111 are under investigation.

“The number of patients with heat illnesses is increasing every year,” said Dr. Aneesh Narang, assistant medical director of emergency medicine at Banner Medical Center-Phoenix, which treats many homeless people with heat stroke.

Narang’s staff works frequently with Circle the City, whose core mission is providing respite care, with 100 beds for homeless people not well enough to return to the streets after a hospital stay.

Extreme heat worldwide requires a dramatic response, said physician assistant Lindsay Fox, who cares for homeless people in Albuquerque, New Mexico, through an initiative run by the University of New Mexico’s School of Medicine.

Three times weekly, Fox treats infections, cleans wounds and manages chronic conditions in consultation with hospital colleagues. She said the prospect of more heat illness worries her.

Highs in Albuquerque can hit the 90s and don’t fall enough for people living outside to cool off overnight, she said.

“If you’re in an urban area that’s primarily concrete, you’re retaining heat,” she said. “We’re seeing heat exposure that very quickly could go to heat stroke.”

Serious heat stroke is far more common in metro Phoenix, where Circle the City is now among scores of health programs for the homeless in cities like New York, San Diego and Spokane, Washington.

Circle the City, founded in 2012 by Sister Adele O’Sullivan, a physician and member of the Sisters of St. Joseph Carondelet, now has 260 employees, including 15 doctors, 13 physician assistants and 11 nurse practitioners. It annually sees 9,000 patients.

Grants, donations and other gifts account for about 20% of the funding. Most of the rest comes from insurance payments for services provided through Medicaid and Medicare.

Circle the City works with medical staff in seven Phoenix hospitals to help homeless patients get after-care when they no longer need hospitalization. It also staffs two outpatient clinics for follow-up.  

“This partnership allows us to offer the best outcomes for our patients,” said Craig Orsini, social work manager at St. Joseph’s Hospital and Medical Center in Phoenix.

Often that’s a few weeks in respite care or, for less acute needs, a stay in one of a handful of medical beds at the downtown shelter for things like dressing changes for wounds. Someone who needs months to heal might go to a skilled nursing facility.

While patients recover, Circle the City works to find longer-term transitional shelter such as those for people 55 and older, or in permanent housing. About 77% of respite patients are sent somewhere other than the street or an emergency shelter.

“We try to find the best fit for people,” said Wendy Adams, Circle the City’s community outreach supervisor.

Circle the City medical staff distributes tens of thousands of water bottles each summer and tries to educate people about hot weather dangers, said Dr. Matt Essary, who works at one of five mobile clinics that stop outside soup kitchens and other services for homeless people. 

Essary said Circle the City is also considering a blood analysis tool to detect electrolyte imbalances caused by dehydration.

“You can see right away how dehydrated they have become because it’s so hard to draw their blood,” he said. Other possible symptoms include headache, extreme thirst, dizziness and dry mouth.

“We also see a lot of people with surface burns,” Essary said of the wounds common in broiling Phoenix, where a medical emergency or intoxication can cause someone to fall on a sizzling sidewalk.

Rachel Belgrade waited outside Circle the City’s retrofitted truck with her black-and-white puppy, Bo, for Essary to write a prescription for the blood pressure medicine she lost when a man stole her bicycle. She accepted two bottles of water to cool off as the morning heat rose. 

“They make all of this easier,” said Belgrade, a Native American from the Gila River tribe. “They don’t give you a hard time.” 
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Beijing — Beijing Tianbing Technology Company said Sunday that the first stage of its Tianlong-3 rocket under development had detached from its launch pad during a test due to structural failure and landed in a hilly area of the city of Gongyi in central China.

There were no reports of casualties after an initial investigation, Beijing Tianbing, also known as Space Pioneer, said in a statement on its official WeChat account.

Parts of the rocket stage were scattered within a “safe area” but caused a local fire, according to a separate statement by the Gongyi emergency management bureau.

The fire has since been extinguished and no one has been hurt, the bureau said.

The two-stage Tianlong-3 (“Sky Dragon 3”) is a partly reusable rocket under development by Space Pioneer, one of a small group of private-sector rocket makers that have grown rapidly over the past five years.

Falling rocket debris in China after launches is not unheard of, but it is very rare for part of a rocket under development to make an unplanned flight out of its test site and crash.

According to Space Pioneer, the first stage of the Tianlong-3 ignited normally during a hot test but later detached from the test bench due to structural failure and landed in hilly areas 1.5 km (0.9 mile) away.

A rocket can consist of several stages, with the first, or lowest, stage igniting and propelling the rocket upward upon its launch.

When the fuel is exhausted, the first stage falls off, and the second stage ignites, keeping the rocket in propulsion. Some rockets have third stages.

Space Pioneer says the performance of Tianlong-3 is comparable to SpaceX’s Falcon 9, which is also a two-stage rocket.

In April 2023, Space Pioneer launched a kerosene-oxygen rocket, the Tianlong-2, becoming the first private Chinese firm to send a liquid-propellant rocket into space.

Chinese commercial space companies have rushed into the sector since 2014 when private investment in the industry was allowed by the state.

Many started making satellites while others including Space Pioneer, focused on developing reusable rockets that can significantly cut mission costs.

The test sites of such companies can be found along China’s coastal areas, located by the sea due to safety reasons.

But some are also sited deep in the country’s interior such as Space Pioneer’s test center in Gongyi, a city of 800,000 people in the central province of Henan.
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SAN JUAN, Puerto Rico — Hurricane Beryl strengthened into what experts called an “extremely dangerous” Category 4 storm as it approaches the southeast Caribbean, which began shutting down Sunday amid urgent pleas from government officials for people to take shelter.

Hurricane warnings were in effect for Barbados, St. Lucia, Grenada, and St. Vincent and the Grenadines. Beryl’s center is expected to pass about 112 kilometers south of Barbados on Monday morning, said Sabu Best, director of Barbados’ meteorological service.

“This is a very serious situation developing for the Windward Islands,” warned the National Hurricane Center in Miami, which said that Beryl was “forecast to bring life-threatening winds and storm surge.”

Beryl was located about 570 kilometers east-southeast of Barbados. It had maximum sustained winds of 215 kph and was moving west at 33 kph. It is a compact storm, with hurricane-force winds extending 30 kilometers from its center.

Beryl is expected to pass just south of Barbados early Monday and then head into the Caribbean Sea as a major hurricane on a path toward Jamaica. It is expected to weaken by midweek, but still remain a hurricane as it heads toward Mexico.

Historic hurricane

Beryl had strengthened into a Category 3 hurricane on Sunday morning, becoming the first major hurricane east of the Lesser Antilles on record for June, according to Philip Klotzbach, Colorado State University hurricane researcher.

It took Beryl only 42 hours to strengthen from a tropical depression to a major hurricane — a feat accomplished only six other times in Atlantic hurricane history, and with Sept. 1 as the earliest date, according to hurricane expert Sam Lillo.

Beryl is now the earliest Category 4 Atlantic hurricane on record, besting Hurricane Dennis, which became a Category 4 storm on July 8, 2005, hurricane specialist and storm surge expert Michael Lowry said.

“Beryl is an extremely dangerous and rare hurricane for this time of year in this area,” he said in a phone interview. “Unusual is an understatement. Beryl is already a historic hurricane and it hasn’t struck yet.”

Hurricane Ivan in 2004 was the last strongest hurricane to hit the southeast Caribbean, causing catastrophic damage in Grenada as a Category 3 storm.

“So this is a serious threat, a very serious threat,” Lowry said of Beryl.

Reecia Marshall, who lives in Grenada, was working a Sunday shift at a local hotel, preparing guests and urging them to stay away from windows as she stored enough food and water for everyone.

She said she was a child when Hurricane Ivan struck, and that she doesn’t fear Beryl.

“I know it’s part of nature. I’m OK with it,” she said. “We just have to live with it.”

Forecasters warned of a life-threatening storm surge of up to 3 meters in areas where Beryl will make landfall, with up to 15 centimeters of rain for Barbados and nearby islands.

Long lines formed at gas stations and grocery stores in Barbados and other islands as people rushed to prepare for a storm that has broken records and rapidly intensified from a tropical storm with 35 mph (56 kph) winds on Friday to a Category 1 hurricane on Saturday.

Warm waters were fueling Beryl, with ocean heat content in the deep Atlantic the highest on record for this time of year, according to Brian McNoldy, University of Miami tropical meteorology researcher. Lowry said the waters are now warmer than they would be at the peak of the hurricane season in September.

Beryl marks the farthest east that a hurricane has formed in the tropical Atlantic in June, breaking a record set in 1933, according to Klotzbach.

“Please take this very seriously and prepare yourselves,” said Ralph Gonsalves, the prime minister of St. Vincent and the Grenadines. “This is a terrible hurricane.”

Bracing for the storm

Thousands of people were in Barbados for Saturday’s Twenty20 World Cup final, cricket’s biggest event, with Prime Minister Mia Mottley noting that not all fans were able to leave Sunday despite many rushing to change their flights.

“Some of them have never gone through a storm before,” she said. “We have plans to take care of them.”

Mottley said that all businesses should close by Sunday evening and warned the airport would close by nighttime.

Kemar Saffrey, president of a Barbadian group that aims to end homelessness, said in a video posted on social media Saturday night that those without homes tend to think they can ride out storms because they’ve done it before.

“I don’t want that to be the approach that they take,” he said, warning that Beryl is a dangerous storm and urging Barbadians to direct homeless people to a shelter.

Echoing his comments was Wilfred Abrahams, minister of home affairs and information.

“I need Barbadians at this point to be their brother’s keeper,” he said. “Some people are vulnerable.”

Meanwhile, St. Lucia Prime Minister Philip J. Pierre announced a national shutdown for Sunday evening and said that schools and businesses would remain closed on Monday.

“Preservation and protection of life is a priority,” he said.

Looking ahead

Caribbean leaders were preparing not only for Beryl, but for a cluster of thunderstorms trailing the hurricane that have a 70% chance of becoming a tropical depression.

“Do not let your guard down,” Mottley said.

Beryl is the second named storm in what is forecast to be an above-average hurricane season, which runs from June 1 to Nov. 30 in the Atlantic. Earlier this month, Tropical Storm Alberto came ashore in northeastern Mexico with heavy rains that resulted in four deaths.

The National Oceanic and Atmospheric Administration predicts the 2024 hurricane season is likely to be well above average, with between 17 and 25 named storms. The forecast calls for as many as 13 hurricanes and four major hurricanes.

An average Atlantic hurricane season produces 14 named storms, seven of them hurricanes and three major hurricanes.
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BADINGILO and BOMA NATIONAL PARKS, South Sudan — Seen from the air, they ripple across the landscape — a river of antelope racing across the vast grasslands of South Sudan in what conservationists say is the world’s largest land mammal migration.

The country’s first comprehensive aerial wildlife survey, released Tuesday, found about 6 million antelope. The survey over a two-week period last year in two national parks and nearby areas relied on spotters in airplanes, nearly 60,000 photos and tracking more than a hundred collared animals over about 120,000 square kilometers.

The estimate from the nonprofit African Parks, which conducted the work along with the government, far surpasses other large migratory herds such as the estimated 1.36 million wildebeests surveyed last year in the Serengeti straddling Tanzania and Kenya. But they warned that the animals face a rising threat from commercial poaching in a nation rife with weapons and without strong law enforcement.

“Saving the last great migration of wildlife on the planet is an incredibly important thing,” said Mike Fay, a conservation scientist who led the survey. “There’s so much evidence that the world’s ecosystems are collapsing, the world resources are being severely degraded and it’s causing gigantic disruption on the planet.”

The east African nation is still emerging from five years of fighting that erupted in 2013 and killed nearly 400,000 people. Elections scheduled for last year were postponed to this December, but few preparations are in place for those. Violence continues in some areas, with some 2 million people displaced and 9 million — 75% of the population — reliant on humanitarian aid, according to the United Nations.

The migration is already being touted as a point of national pride by a country trying to move beyond its conflict-riddled past. Billboards of the migration recently went up in the capital of Juba, and the government has aspirations that the animals may someday be a magnet for tourists.

South Sudan has six national parks and a dozen game reserves covering more than 13% of the terrain. The migration stretches from east of the Nile in Badingilo and Boma parks into neighboring Ethiopia — an area roughly the size of the U.S. state of Georgia. It includes four main antelope, the white-eared kob — of which there are some 5 million — the tiang, the Mongalla gazelle and bohor reedbuck.

The survey said some animals have increased since a more limited one in 2010. But it described a “catastrophic” decline of most non-migratory species in the last 40 years, such as the hippo, elephant and warthog. Associated Press journalists flying over the stunning migration of thousands of antelope last week saw few giraffes and no elephants, lions or cheetahs.

Trying to protect the animals over such a vast terrain is challenging.

In recent years, new roads have increased people’s access to markets, contributing to poaching. Years of flooding have meant crop failures that have left some people with little choice but to hunt for food. Some 30,000 animals were being killed each month between March and May this year, African Parks estimated.

The government hasn’t made a priority of protecting wildlife. Less than 1% of its budget is allocated to the wildlife ministry, which said it has few cars to move rangers around to protect animals. Those rangers say they haven’t been paid a salary since October and are outgunned by poachers.

South Sudan President H.E. Salva Kiir Mayardit said the country is committed to turning its wealth of wildlife into sustainable tourism. He called on the Ministry of Wildlife to prioritize training and equipping rangers to fight poaching.

Matthew Kauffman, a wildlife biologist for the U.S. Geological Survey and a professor of zoology at the University of Wyoming, said the work fits a growing global effort “to map these migrations.” One benefit is to be smarter when landscapes are developed to make way for these seasonal movements, he said.

Villagers near the parks told AP they mostly hunted to feed their families or to barter for goods.

A newly paved road between Juba and Bor — the epicenter of the illegal commercial bushmeat trade — has made it easier for trucks to carry large quantities of animals. Bor sits along the Nile, about 45 kilometers from Badingilo Park. In the dry season, animals coming closer to the town to drink are vulnerable to killing.

Officials at the wildlife ministry in Bor told AP the killing of animals had doubled in the last two years.

Even when those involved in the industry are caught, the consequences can be minor. A few years ago, when wildlife rangers came to arrest Lina Garang for selling animals, she said they let her go, instead telling her to conduct business more discreetly. Garang, 38, said her competition has only grown, with 15 new shops opening along her strip to buy and sell animals.

Part of the challenge is that there is no national land management plan, so roads and infrastructure are built without initial discussions about where best placed. The government’s also allocated an oil concession to a South African company in the middle of Badingilo that spans nearly 90% of the park.

African Parks is trying to square modernizing the country with preserving the wildlife. The organization has been criticized in the past for not engaging enough with communities and taking an overly militarized approach in some of the nearly two dozen areas it manages in Africa.

The group says its strategy in South Sudan is focused on community relations and aligning the benefits of wildlife and economic development. One plan is to create land conservancies that local communities would manage, with input from national authorities.

African Parks has set up small hubs in several remote villages and is spreading messages of sustainable practices, such as not killing female or baby animals.

Peter Alberto, undersecretary for the ministry of wildlife, conservation and tourism, said the government hopes the migration can become a point of pride, and reshape how the world thinks of South Sudan.

As for tourism, that may take a while. There aren’t hotels or roads to host people near the parks, and the only option is high-end trips for what one tour company official called a “high-risk” audience. There’s fighting between tribes and attacks by gunmen in the area, and pilots told AP they’ve been shot at while flying.

Will Jones, chief exploration officer for Journeys by Design, a U.K.-based tour company, charges roughly $150,000 per person for a weeklong tour in South Sudan. He said there isn’t strong demand.

Locals trying to protect the wildlife say it’s hard to shift people’s mentality.

In the remote village of Otallo on the border with Ethiopia, young men have started buying motorbikes. What had been an all-day trip on foot to cross the border to sell animals now takes just five hours, allowing them to double the number of animals they take and make multiple trips.

One of them, Charo Ochogi, said he’d rather be doing something else but there are few options, and he’s not worried about the animals disappearing.

“The kob isn’t going to finish. They’ll reproduce,” he said.
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SAN JUAN, Puerto Rico — Beryl strengthened into a hurricane Saturday as it churned toward the southeast Caribbean, with forecasters warning it was expected to strengthen into a dangerous major hurricane before reaching Barbados late Sunday or early Monday. 

A major hurricane is considered a Category 3 or higher, with winds of at least 178 kph. Beryl is now a Category 1 hurricane. 

A hurricane warning was issued for Barbados, and a hurricane watch was in effect for St. Lucia, Grenada, and St. Vincent and the Grenadines, while a tropical storm watch was issued for Martinique, Dominica and Tobago.  

“It’s astonishing to see a forecast for a major (Category 3+) hurricane in June anywhere in the Atlantic, let alone this far east in the deep tropics. #Beryl organizing in a hurry over the warmest waters ever recorded for late June,” Florida-based hurricane expert Michael Lowry posted on X. 

Beryl’s center is forecast to pass about 45 kilometers (about 28 mi) south of Barbados, said Sabu Best, director of the island’s meteorological services. 

On Saturday, Beryl was about 1,160 kilometers (about 721 mi) east-southeast of Barbados, with maximum sustained winds of 120 kph. It was moving west at 35 kph. 

“Rapid strengthening is now forecast,” the Miami-based National Hurricane Center said. 

Warm waters are fueling Beryl, with ocean heat content in the deep Atlantic the highest on record for this time of year, according to Brian McNoldy, University of Miami tropical meteorology researcher. 

Beryl is the strongest June tropical storm on record that far east in the tropical Atlantic, noted Philip Klotzbach, Colorado State University hurricane researcher. 

“We need to be ready,” Barbadian Prime Minister Mia Mottley said in a public address late Friday. “You and I know when these things happen, it is better to plan for the worst and pray for the best.” 

She noted that thousands of people were in Barbados for the Twenty20 World Cup cricket final in the capital, Bridgetown, on Saturday.  

Some fans, such as Shashank Musku, a 33-year-old physician who lives in Pittsburgh, Pennsylvania, were rushing to change their flights to leave before the storm. 

Musku has never experienced a hurricane: “I don’t plan on being in one, either.” 

Meanwhile, St. Vincent and the Grenadines Prime Minister Ralph Gonsalves said in a public address Saturday that shelters will open Sunday evening as he urged people to prepare. He ordered officials to refuel government vehicles and asked grocery stores and gas stations to stay open later before the storm. 

Beryl is the second named storm in what is predicted to be a busy hurricane season, which runs from June 1 to November 30 in the Atlantic. Earlier this month, Tropical Storm Alberto came ashore in northeast Mexico with heavy rains that resulted in four deaths. 

Mark Spence, manager of a hostel in Barbados, said in a phone interview that he was calm about the approaching storm. 

“It’s the season. You can get a storm any time,” he said. “I’m always prepared. I always have enough food in my house.” 

The National Oceanic and Atmospheric Administration predicts the 2024 hurricane season is likely to be well above average, with between 17 and 25 named storms. The forecast calls for as many as 13 hurricanes and four major hurricanes. 

Beryl is expected to drop up to 15 centimeters (about 6 inches) of rain in Barbados and nearby islands, and a high surf warning of waves up to 4 meters (13 feet) was in effect. A storm surge of up to 2 meters (6.6 feet) is also forecast. 
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DEIR AL-BALAH, Gaza — Children in sandals trudge through water contaminated with sewage and scale growing mounds of garbage in Gaza’s crowded tent camps for displaced families. People relieve themselves in burlap-covered pits, with nowhere nearby to wash their hands.

In the stifling summer heat, Palestinians say the odor and filth surrounding them is just another inescapable reality of war — like pangs of hunger or sounds of bombing.

The territory’s ability to dispose of garbage, treat sewage and deliver clean water has been virtually decimated by eight brutal months of war between Israel and Hamas. This has made grim living conditions worse and raised health risks for hundreds of thousands of people deprived of adequate shelter, food and medicine, aid groups say.

Hepatitis A cases are on the rise, and doctors fear that as warmer weather arrives, an outbreak of cholera is increasingly likely without dramatic changes to living conditions. The U.N., aid groups and local officials are scrambling to build latrines, repair water lines and bring desalination plants back online.

COGAT, the Israeli military body coordinating humanitarian aid efforts, said it’s engaging in efforts to improve the “hygiene situation.” But relief can’t come soon enough.

“Flies are in our food,” said Adel Dalloul, a 21-year-old whose family settled in a beach tent camp near the central Gaza city of Nuseirat. They wound up there after fleeing the southern city of Rafah, where they landed after leaving their northern Gaza home. “If you try to sleep, flies, insects and cockroaches are all over you.”

More than a million Palestinians had been living in hastily assembled tent camps in Rafah before Israel invaded in May. Since fleeing Rafah, many have taken shelter in even more crowded and unsanitary areas across southern and central Gaza that doctors describe as breeding grounds for disease — especially as temperatures regularly reach 32 degrees Celsius.

“The stench in Gaza is enough to make you kind of immediately nauseous,” said Sam Rose, a director at the U.N. agency for Palestinian refugees.

Conditions are exacting an emotional toll, too.

Anwar al-Hurkali, who lives with his family in a tent camp in the central Gazan city of Deir al-Balah, said he can’t sleep for fear of scorpions and rodents. He doesn’t let his children leave their tent, he said, worrying they’ll get sick from pollution and mosquitoes.

“We cannot stand the smell of sewage,” he said. “It is killing us.”

Basic services breakdown

The U.N. estimates nearly 70% of Gaza’s water and sanitation plants have been destroyed or damaged by Israel’s heavy bombardment. That includes all five of the territory’s wastewater treatment facilities, plus water desalination plants, sewage pumping stations, wells and reservoirs.

The employees who once managed municipal water and waste systems have been displaced, and some killed, officials say. This month, an Israeli strike in Gaza City killed five government employees repairing water wells, the city said.

Despite staffing shortages and damaged equipment, some desalination plants and sewage pumps are working, but they’re hampered by lack of fuel, aid workers say.

A U.N. assessment of two Deir al-Balah tent camps found in early June that people’s daily water consumption — including drinking, washing and cooking — averaged under 2 liters, far lower than the recommended 15 liters a day.

COGAT said it’s coordinating with the UN to repair sewage facilities and Gaza’s water system. Israel has opened three water lines “pumping millions of liters daily” into Gaza, it said.

But people often wait hours in line to collect potable water from delivery trucks, hauling back to their families whatever they can carry. The scarcity means families often wash with dirty water.

This week, Dalloul said, he lined up for water from a vendor. “We discovered that it was salty, polluted, and full of germs. We found worms in the water. I had been drinking from it,” he said. “I had gastrointestinal problems and diarrhea, and my stomach hurts until this moment.”

The World Health Organization declared an outbreak of hepatitis A that, as of early June, had led to 81,700 reported cases of jaundice — a common symptom. The disease spreads primarily when uninfected people consume water or food contaminated with fecal matter.

Because wastewater treatment plants have shut down, untreated sewage is seeping into the ground or being pumped into the Mediterranean Sea, where tides move north toward Israel.

“If there are bad water conditions and polluted groundwater in Gaza, then this is an issue for Israel,” said Rose, of the U.N. agency for Palestinian refugees. “It has in the past prompted actions by Israel to try and ameliorate the situation.”

COGAT said it’s working on “improving waste management processes” and examining proposals to establish new dumps and allow more garbage trucks into Gaza.

Where can garbage go?

Standing barefoot on a street in the Nuseirat refugee camp, 62-year-old Abu Shadi Afana compared the pile of garbage next to him to a “waterfall.” He said trucks continue to dump rubbish even though families live in tents nearby.

“There is no one to provide us with a tent, food, or drink, and on top of all of this, we live in garbage?” Afana said. Trash attracts bugs he’s never seen before in Gaza — small insects that stick to his skin. When he lies down, he said, he feels like they’re “eating his face.”

There are few other places for the garbage to go. When Israel’s military took control of a 1-kilometer buffer zone along its border with Gaza, two main landfills east of the cities of Khan Younis and Gaza City became off-limits.

In their absence, informal landfills have developed. Displaced Palestinians running out of areas to shelter say they’ve had little choice but to pitch tents near trash piles.

Satellite images from Planet Labs analyzed by The Associated Press show that an informal landfill in Khan Younis that sprung up after October 7 appears to have doubled in length since January. Since the Rafah evacuation, a tent city has sprung up around the landfill, with Palestinians living between piles of garbage.

Cholera fears

Doctors in Gaza fear cholera may be on the horizon.

“The crowded conditions, the lack of water, the heat, the poor sanitation — these are the preconditions of cholera,” said Joanne Perry, a doctor working in southern Gaza with Doctors Without Borders.

Most patients have illnesses or infections caused by poor sanitation, she said. Scabies, gastrointestinal illnesses and rashes are common. More than 485,000 diarrhea cases have been reported since the war’s start, WHO says.

“When we go to the hospital to ask for medicine for diarrhea, they tell us it is not available, and I go to buy it outside the hospital,” al-Hurkali said. “But where do I get the money?”

COGAT says it’s coordinating delivery of vaccines and medical supplies and is in daily contact with Gaza health officials. COGAT is “unaware of any authentic, verified report of unusual illnesses other than viral illnesses,” it said.

With efforts stalled to broker a cease-fire between Israel and Hamas, Dalloul says he’s lost hope that help is on the way.

“I am 21 years old. I am supposed to start my life,” he said. “Now I just live in front of the garbage.” 
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ABUJA, Nigeria — Yunusa Bawa spends a lot of time talking about the vaccine for the human papillomavirus that is responsible for nearly all cases of cervical cancer. But on most days, only two or three people allow their daughters to be vaccinated in the rural part of Nigeria where he works.

The challenge in Sabo community, on the outskirts of the capital of Abuja, is the unfounded rumor that the HPV vaccine will later keep young girls from giving birth.

“The rumor is too much,” said Bawa, 42.

As more African countries strive to administer more HPV vaccines, Bawa and other health workers tackle challenges that slow progress, particularly misinformation about the vaccine. The World Health Organization’s Africa office estimates that about 25% of the population still has doubts about it — reflecting concerns seen in some other parts of the world in early campaigns for the vaccine.

A common sexually transmitted virus, HPV can cause cervical cancer, certain other cancers and genital warts. In most cases, the virus doesn’t cause any problems, but some infections persist and eventually lead to cancer.

Across Africa, an average of 190 women died daily from cervical cancer in 2020, accounting for 23% of the deaths globally and making it the leading cancer killer among women in the WHO Africa region of 47 countries. Eighteen of the 20 countries with the highest rate of cervical cancer cases in the world are in Africa. Yet the region’s HPV vaccination rate has been low.

More than half of Africa’s 54 nations – 28 – have introduced the vaccine in their immunization programs, but only five have reached the 90% coverage that the continent hopes to achieve by 2030. Across the region, 33% of young girls have been vaccinated with HPV.

It’s a stark contrast to most European countries, where both girls and boys have been receiving HPV shots.

Part of why Africa has a high burden of cervical cancer is because of limited access to screening for women, said Emily Kobayashi, head of the HPV Program at the vaccines alliance Gavi.

“The elimination strategy is a long game … but we know that vaccination is the strongest pillar and one of the easiest to implement,” Kobayashi said.

But “it is one thing to introduce the vaccine, but if the vaccine remains in the fridge, it doesn’t prevent cervical cancer,” said Charles Shey Wiysonge, head of the vaccine-preventable diseases program in the WHO’s Africa region. He said information must be provided by people “who are trusted, people who are close to the communities.”

There is a long history of vaccine hesitancy in many African countries that is sometimes linked to a lack of trust in government, as one study published in the Nature science journal in May found, giving room for conspiracy theories and misinformation from social media influencers and religious leaders.

In Zimbabwe, where cervical cancer is the most frequent cancer among women, a group of mostly women known as Village Health Workers have been trained to raise awareness about cervical cancer and the HPV vaccine in rural areas. But they fight a high level of hesitancy among religious sects that discourage followers from modern medicines, asking them to rely instead on prayers and “anointed” water and stones.

The women who eventually agree to be screened for cervical cancer do so in secret, said Zanele Ndlovu, one of the health workers on the outskirts of Bulawayo city.

For a deeply religious country like Zimbabwe, “the spiritual leaders have so much influence that a lot of our time is taken trying to educate people about the safety of vaccines, or that they are not ungodly,” Ndlovu said.

There are also success stories in Africa where authorities have achieved up to a 90% vaccination rate. One example is Ethiopia, which relies heavily on religious leaders, teachers and hotline workers.

In Rwanda, the first African country to implement a national HPV vaccination program in 2011, the coverage rate has reached 90%. Hesitancy is less of an issue due to vigorous awareness work that has relied on school-based campaigns and community outreach programs, said Dr. Theoneste Maniragaba, director of the cancer program at Rwanda Biomedical Center.

Mozambique has deployed school-based programs, a door-to-door approach and mobile outreach for girls in hard-to-reach areas that has helped it reach 80% coverage rate with the first of two doses. In Tanzania, where the HPV vaccine has been in use since at least 2018, authorities in April launched a campaign to target over 5 million girls and further raise coverage, which has reached 79% of girls with the first dose.

One of Africa’s largest HPV vaccination drives targeting girls recently kicked off in Nigeria, which has procured nearly 15 million doses with the help of the U.N. children’s agency. It will target girls ages 9–14 with single doses that the WHO’s African immunization advisory group has said is as effective as the regular two doses.

One challenge is explaining the HPV vaccination to girls ahead of the onset of sexual activity, especially in conservative societies, said Dr. Aisha Mustapha, a gynecologist in northern Kaduna state.

Mustapha has been successfully treated for cervical cancer. She said the experience helps in her meetings with religious leaders and in community outreach programs in Kaduna, where she leads the Medical Women Association of Nigeria.

They try to make the girls feel comfortable and understand why the vaccine is important, she said. That sometimes requires comic books and lots of singing.

“The (cervical) cancer … is no respecter of any identity,” she said. “The vaccine is available, it is free, it is safe and effective.”
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Nigeria is one of the world’s leading producers of ginger, but a massive outbreak of fungal disease last year caused millions of dollars of damage. The Nigerian government has launched an emergency recovery intervention to help ginger farmers. Timothy Obiezu reports from Kaduna.
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WASHINGTON — Catastrophic Canadian wildfires last year pumped more heat-trapping carbon dioxide into the air than India did by burning fossil fuels, setting ablaze an area of forest larger than the U.S. state of West Virginia, new research finds.

Scientists at the World Resources Institute and the University of Maryland calculated how devastating the impacts were of the monthslong fires in Canada in 2023 that sullied the air around large parts of the globe. They figured it put 2.98 billion metric tons of heat-trapping carbon dioxide into the air, according to a study update published in Thursday’s Global Change Biology. The update is not peer-reviewed, but the original study was.

The fire spewed nearly four times the carbon emissions as airplanes do in a year, study authors said. It’s about the same amount of carbon dioxide that 647 million cars put in the air in a year, based on U.S. Environmental Protection Agency data.

Forests “remove a lot of carbon from the atmosphere and that gets stored in their branches, their trunks, their leaves and kind of in the ground as well. So, when they burn all the carbon that’s stored within them, [it] gets released back into the atmosphere,” said the study’s lead author, James MacCarthy, a research associate with WRI’s Global Forest Watch.

When and if trees grow back, much of that can be recovered, MacCarthy said, adding, “It definitely does have an impact on the global scale in terms of the amount of emissions that were produced in 2023.”

MacCarthy and colleagues calculated that the forest burned totaled 77,574 square kilometers (29,951 square miles), which is six times more than the average from 2001 to 2022. The wildfires in Canada made up 27% of global tree cover loss last year; usually it’s closer to 6%, MacCarthy’s figures show.

These are far more than regular forest fires, but researchers focused only on tree cover loss, which is a bigger effect, said study co-author Alexandra Tyukavina, a geography professor at the University of Maryland.

Syracuse University geography and environment professor Jacob Bendix, who wasn’t part of the study, said, “The loss of that much forest is a very big deal, and very worrisome.

“Although the forest will eventually grow back and sequester carbon in doing so, that is a process that will take decades at a minimum, so that there is a quite substantial lag between addition of atmospheric carbon due to wildfire and the eventual removal of at least some of it by the regrowing forest,” he said.

“So, over the course of those decades, the net impact of the fires is a contribution to climate warming.”

It’s more than just adding to heat-trapping gases and losing forests; there were health consequences as well, Tyukavina said.

“Because of these catastrophic fires, air quality in populated areas and cities was affected last year,” she said, mentioning New York City’s smog-choked summer. More than 200 communities with about 232,000 residents had to be evacuated, according to another not-yet-published or peer-reviewed study by Canadian forest and fire experts.

One of the authors of the Canadian study, fire expert Mike Flannigan at Thompson Rivers University in Kamloops, British Columbia, puts the acreage burned at twice what MacCarthy and Tyukavina do.

“The 2023 fire season in Canada was [an] exceptional year in any time period,” Flannigan, who wasn’t part of the WRI study, said in an email. “I expect more fire in our future, but years like 2023 will be rare.”

Flannigan, Bendix, Tyukavina and MacCarthy all said climate change played a role in Canada’s big burn. A warmer world means a longer fire season, more lightning-caused fires and especially drier wood and brush to catch fire “associated with increased temperature,” Flannigan wrote.

The average May-to-October temperature in Canada last year was almost 2.2 degrees Celsius warmer than normal, his study found. Some parts of Canada were 8 to 10 degrees Celsius hotter than average in May and June, MaCarthy said.

There’s short-term variability within trends, so it’s hard to blame one specific year and area on climate change, and geographic factors play a role, Bendix said in an email, but still, “there is no doubt that climate change is the principal driver of the global increases in wildfire.”

With the world warming from climate change, Tyukavina said, “The catastrophic years are probably going to be happening more often, and we are going to see those spikier years more often.”
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Jakarta, Indonesia — Indonesia aims to launch 19 satellites into low-Earth orbit next year, part of an ambitious plan to move the country into the forefront of the world’s growing space industry and reduce its reliance on other countries for its satellite data.

The broader program, known as the 2045 space map, is set to begin next year. Officials hope to boost Indonesia’s economy and drive foreign direct investment by leveraging its unique geography as a near-equatorial, fuel-efficient launch point for space travel and research.

While the satellite launches would support key economic sectors such as agriculture and mining with remote-sensing technology to track weather patterns, mining emissions and mineral-rich areas, the longer-term plan includes development of a leading-edge spaceport to reduce reliance on foreign launch sites.

But according to officials at BRIN, Indonesia’s National Research and Innovation Agency, there’s still no confirmation of which company or government agencies would be responsible for the spate of launches planned for 2025.

“The main constraint was the government’s financial planning and budget cuts. We also couldn’t clinch foreign investment partners to join in developing the spaceport because it is high technology and high cost,” said BRIN researcher Thomas Djamalludin.

Starlink, SpaceX and Elon Musk

Jakarta has relied on Elon Musk’s SpaceX for launching its satellites from Cape Canaveral, Florida, since 2019, and the billionaire entrepreneur last month launched a Starlink internet services satellite directly from Bali.

Indonesian President Joko Widodo has repeatedly invited Musk to use the Papuan province island of Biak as a primary Starlink launch site, which has drawn outrage from locals who say developing the island as a spaceport will devastate its fragile ecology.

Although Biak has an airstrip, military base, deep-water seaport and ground stations, the 500 hectares (1.9 square miles) of government-owned land suitable for the spaceport would require foreign investment to cover the preliminary $613 million required to build the initial phase of the project. The total cost is dependent on what additional facilities investors want to build at the space port.

Luhut Pandjaitan, Indonesia’s coordinating minister for maritime affairs and investment, said that Starlink is mulling the offer but that there are no immediate plans for collaboration.

According to Djamalludin of BRIN, China, which has dominated Indonesia’s 5G market and is on track to be the nation’s largest foreign investor, had expressed interest. However, a catastrophic April 2020 rocket launch that destroyed Indonesia’s $220 million Nusantara-2 satellite has complicated Jakarta’s relationship with China’s state-owned China Great Wall Industry Corporation.

Beijing has since dialed back its financial interests, declaring the Biak location too distant, while Jakarta has doubled down on wooing SpaceX for the upcoming launches, deeming the company more reliable, offering more time slots and cheaper reusable rockets.

Indonesia’s director of investment promotion at the Investment Coordinating Board, Saribua Siahaan, told VOA that Jakarta continues offering financial incentives, along with an easy investment permitting process for public-private partnerships.

No takers in 2023

As recently as 2023, BRIN officials promoted their spaceport plans at the G20 Space Economy Leaders’ Meeting and Asia-Pacific Regional Space Agency Forum. China, Russia, Japan, South Korea and India were invited as potential partners, but none signed on.

“Despite the 2013 Space Law having been in effect for nearly a decade, [Indonesia’s] government has yet to finalize implementing regulations for commercialization of space and spaceport development,” said Indonesian space-law scholars Ridha Aditya Nugraha and Yaries Mahardika Putro in a recent Jakarta Post op-ed.

Indonesia was the first country in ASEAN to enforce national space legislation. The 2013 Space law provides a legal framework regarding outer space, and it lays the foundation for space industry growth.

Foreign direct investment in space activities brings legal certainty that can attract investors. In the past decade, though, implementation of regulations has not occurred and that has made it difficult for the related ministeries to make Indonesia a space-faring country.

“This must be resolved immediately if Indonesia is serious about making outer space a revenue center and the driver of the economy in the future,” the op-ed said.
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