“Measles is back, and it’s a wake-up call,” warned Dr. Hans Kluge, the World Health Organization (WHO) regional director for the European region.

A total of 127,350 cases were reported in the region in 2024, double the number of cases reported for 2023 and the highest number since 1997, according to analysis by WHO and the UN Children’s Fund (UNICEF).

Among the most contagious viruses affecting people, measles can damage the immune system by “erasing” its memory of how to fight infections, leaving survivors vulnerable to other diseases.

As well as hospitalisation and death caused by complications including pneumonia, encephalitis, diarrhoea and dehydration, measles can also cause long-term, debilitating health complications such as blindness.

Deaths reported

There were an estimated 107,500 measles deaths globally in 2023, mostly among unvaccinated or under vaccinated children under five, according to WHO.

“Measles remains a significant global threat,” the UN agencies said, pointing to the 359,521 cases reported for 2024 worldwide.

Current outbreaks and deaths have been reported worldwide, including in the Democratic Republic of the Congo, the United States and countries in every other region.

Based on preliminary data received as of 6 March 2025, a total of 38 deaths have been reported for WHO’s European region, which comprises 53 countries in Europe and Central Asia.

Post-COVID-19 surge

The region accounted for one third of all measles cases globally in 2024.

UN agencies pointed to a resurgence in 2018 and 2019, with 89,000 and 106,000 cases respectively, after a period of decline since 1997, with 216,000 reported cases, that reached a low of 4,440 in 2016.

Following a backsliding in immunisation coverage during the COVID-19 pandemic, cases rose significantly again in 2023 and 2024, the UN agencies said, adding that vaccination rates in many countries are yet to return to pre-pandemic levels, increasing the risk of outbreaks.

Transmission of the virus across borders and continents occurs regularly, and outbreaks of this highly infectious disease will occur wherever the virus finds pockets where vaccine levels are insufficient – particularly children, they cautioned.

Currently, children under five accounted for more than 40 per cent of reported cases in the region, and more than half of all cases required hospitalisation.

Calls for urgent government action

“Measles cases across Europe and Central Asia have soared over the past two years, pointing to gaps in immunisation coverage,” said Regina De Dominicis, UNICEF regional director for Europe and Central Asia.

In 2023 alone, 500,000 children across the region missed the first dose of the measles vaccine (MCV1) that should be given through routine immunisation services.

“To protect children from this deadly and debilitating disease, we need urgent government action including sustained investment in health care workers,” she said.

‘No health security’ without vaccines

WHO’s Dr. Kluge said “we can’t afford to lose ground” as the agency shapes its regional health strategy to tackle such serious issues.

“Without high vaccination rates, there is no health security,” Dr. Kluge said.

“Every country must step up efforts to reach under-vaccinated communities. The measles virus never rests and neither can we.”

Indeed, vaccination is the best line of defence against the virus, the UN agencies insisted.

Outbreak hot spots

The latest analysis found that Romania reported the highest number of cases – 30,692 – in the region for 2024, followed by 28,147 in Kazakhstan.

At the same time, less than 80 per cent of eligible children in Bosnia and Herzegovina, Montenegro, North Macedonia and Romania were vaccinated with MCV1 in 2023.

In both Bosnia and Herzegovina and Montenegro, the coverage rate for MCV1 has remained below 70 per cent and 50 per cent respectively for the past five or more years.

That is far below the 95 per cent coverage rate required to retain herd immunity, the UN agencies noted.

Catch-up campaigns

UNICEF and WHO are working with governments and health partners, including the European Union and the GAVI Alliance, to prevent and respond to measles outbreaks by engaging with communities.

Efforts include training healthcare workers, strengthening vaccine programmes and disease surveillance systems and initiating measles immunisation catch-up campaigns.

The UN agencies are calling for governments with active outbreaks to urgently intensify case finding, contact tracing and conduct emergency vaccination campaigns.

Analysing root causes

“It is imperative that countries analyse the root causes of outbreaks, address weaknesses in their health systems and strategically utilise epidemiological data to identify and close coverage gaps,” the UN agencies stated.

Reaching hesitant parents and marginalised communities and tackling inequitable access to vaccines must be central to all efforts, they added.

They also warned that countries that do not have current measles outbreaks should be prepared, including through identifying and addressing gaps in immunity, building and sustaining public trust in vaccines and maintaining strong health systems.

Egypt’s economy, once buoyed by a thriving middle class and ambitious development projects, now finds itself in the grips of a prolonged crisis. Amid a series of International Monetary Fund (IMF)-backed economic reforms, the middle class, long considered the backbone of the Arab world’s most populous nation, is crumbling under the weight of rising costs and dwindling purchasing power.

From household essentials to minor luxuries, many Egyptians are struggling to afford what were once considered basics. The IMF’s recommendations—liberalizing the currency exchange, reducing subsidies, and implementing fiscal austerity—have intensified a years-long economic crisis that shows little sign of easing.

For 27-year-old Nourhan Khaled, even modest indulgences like perfumes and chocolates are out of reach.

“All my salary goes to transport and food,” she lamented while shopping at a supermarket in western Cairo. She paused over her cart, weighing each item’s necessity.

Similarly, Zeinab Gamal, a 28-year-old housewife, has had to cut back on her family’s consumption of basic items like milk.

“We don’t buy sweets anymore and have reduced milk consumption,” she said, pointing to the sharp trade-offs her family faces daily.

These adjustments underscore a seismic shift in lifestyles, particularly among the middle class. Manar, a 38-year-old mother of two, recalled the stark contrast between her childhood and her family’s current struggles.

“The lifestyle I grew up with has completely changed,” she said. Despite taking a part-time teaching job to increase her household income to 15,000 Egyptian pounds (around $304), her family now views children’s sports activities as a “luxury.” Even meat consumption has been slashed, with meals that once featured it four times a week reduced to just two.

In August, Egypt raised fuel prices for the third time in 2024, with a 17.5% hike that exacerbated transportation and living costs. These measures are part of an $8 billion IMF loan program, which was expanded this year from an initial $3 billion to address Egypt’s dire economic situation.

While the IMF advocates these policies as necessary for stabilizing the economy, their implementation has led to skyrocketing prices for food, medicine, and transportation. Experts and citizens alike warn of severe repercussions for the average Egyptian.

“The current reforms have had a more intense effect on people compared to previous rounds,” said Wael Gamal, director of the social justice unit at the Egyptian Initiative for Personal Rights. He suggested a more gradual implementation could have mitigated some of the fallout.

Foreign debt has quadrupled since 2015, now standing at $160.6 billion in the first quarter of 2024. Much of this debt has been funneled into ambitious infrastructure projects, including a sprawling new administrative capital east of Cairo. Critics argue that while these projects may promise long-term benefits, they have contributed to the current fiscal strain without providing immediate relief to citizens.

The ongoing war in Gaza has compounded Egypt’s woes. Huthi rebel attacks on Red Sea shipping, carried out in solidarity with Palestinians, have slashed revenues from the Suez Canal—a vital source of foreign currency—by over 70% this year.

Public frustration with rising costs and dwindling incomes has prompted officials to signal potential changes to the IMF-backed program. Last month, President Abdel Fattah al-Sisi hinted at the need for a re-evaluation.

“If these challenges will make us put unbearable pressure on public opinion, then the situation must be reviewed with the IMF,” Sisi said. Prime Minister Mostafa Madbouly also assured citizens that no further financial burdens would be imposed “in the coming period,” though he offered no specifics on timing.

Egypt’s current predicament is not without precedent. In 2016, the government embarked on a three-year, $12-billion IMF loan program that led to significant reforms, including the first in a series of currency devaluations. The Egyptian pound has since lost much of its value, with one U.S. dollar now worth more than 49 Egyptian pounds.

While poverty rates officially dropped from 32.5% in 2019 to 29.7% in 2020, these figures fail to capture the growing ranks of a struggling middle class. Many who previously enjoyed financial stability now grapple with daily challenges.

“Two years ago, we had no trouble affording basics,” said Manar. “Now, I think twice before buying essentials like food and clothing.”

Earlier this month, IMF Managing Director Kristalina Georgieva defended the program’s long-term goals, claiming that reforms would lead to “a more dynamic, more prosperous Egyptian economy.” However, the delayed IMF review of the loan program underscores lingering concerns about its implementation. If completed, the review could unlock $1.2 billion in additional financing for Egypt.

Despite these assurances, ordinary Egyptians remain wary. For Manar, optimism feels far-fetched. Her family relies on her brother, an expatriate, to send basic items like instant coffee, which now costs 400 pounds ($8) per jar.

“All I can think about now is what we will do if there are more price increases in the future,” she said.

Wael El-Nahas, an economist and capital market specialist, described the IMF loan program as a “bitter pill to swallow.” Yet, he acknowledged its role in compelling the government to adopt systematic reforms.

“The IMF provides a crucial tool for discipline,” he said. “But the pace of reforms needs to account for social realities.”

Echoing this sentiment, Gamal from the Egyptian Initiative for Personal Rights stressed the need for a slower, more deliberate approach.

Egyptian expatriates send home an estimated $30 billion annually, a vital lifeline for families struggling to make ends meet. Still, this influx of foreign currency is not enough to stem the tide of hardship. For the once-thriving middle class, the erosion of living standards has created a precarious existence.

As Egypt grapples with its worst economic crisis in decades, the divide between economic reforms and public well-being has widened. For many, the sacrifices demanded by IMF-backed measures feel unsustainable, turning everyday essentials into unattainable luxuries.

Eastern Indonesia’s Mount Lewotobi Laki-Laki erupted again on Saturday, November 9, sending a colossal ash plume over 9 kilometers into the sky, following a series of eruptions that began earlier this week. This latest eruption—recorded at 4:47 a.m. local time—marks another in a relentless series of explosions that have claimed the lives of nine people, displaced thousands, and left a lasting mark on the region.

Mount Lewotobi Laki-Laki, a towering 1,703-meter volcano on Flores Island, has erupted over a dozen times within days, sending communities into turmoil and creating an emergency for local and national authorities.

According to Indonesia’s Center for Volcanology and Geological Hazard Mitigation (PVMBG), the ash cloud from Saturday’s eruption reached a staggering altitude of approximately 9,000 meters above the volcano’s summit. The massive ash column was described as “grey with thick intensity,” a signal of the eruption’s violence and potential impact on both air quality and visibility across wide areas. In response, authorities are maintaining an exclusion zone of 8 kilometers around the volcano, urging locals to stay alert for further hazardous developments.

Saturday’s eruption came on the heels of a similarly intense eruption on Friday that forced the evacuation of monitoring officials stationed nearby. On Thursday, the volcano had already discharged an ash tower nearly 8 kilometers high, which witnesses described as one of the largest they had seen in recent years.

Mount Lewotobi Laki-Laki’s eruptions have left the local community on edge, facing life-altering risks as the mountain continues to show little sign of quieting. The tremors and ash clouds have affected over 10,000 people, with many forced to abandon their homes within the exclusion zone.

Although no immediate reports of new damage emerged following Saturday’s eruption, authorities warned of potential lahars, or cold lava flows. Heavy rainfall anticipated in the coming days could combine with volcanic debris to create hazardous mudflows capable of engulfing nearby villages and farmlands. The Indonesian disaster mitigation agency has urged residents to stay vigilant, with the possibility of cold lava floods presenting a severe risk to the already vulnerable region.

Given the scale and recurrence of the eruptions, local authorities have prioritized permanent relocation for thousands of residents who live near Mount Lewotobi Laki-Laki. Many evacuees, uncertain of when or if they will be able to return home, are currently housed in temporary shelters provided by the government. The head of Indonesia’s National Disaster Mitigation Agency, Suharyanto, noted during a recent visit to an evacuation center that authorities are working swiftly to secure permanent housing solutions for affected families.

“Since the preparation and planning process for relocation takes time, we hope we can build them quickly,” Suharyanto said, underscoring the logistical challenges of rehousing displaced residents in the midst of a volatile eruption cycle. While authorities have pledged to provide funding and resources to facilitate a safe relocation, evacuees must grapple with the uncertainty of leaving their ancestral lands and livelihoods.

Mount Lewotobi Laki-Laki, whose name means “man” in Indonesian, is one of two twin peaks situated on the tourist-dotted island of Flores. The twin volcano’s counterpart, Mount Lewotobi Perempuan, meaning “woman,” has largely remained calm in comparison. This unusual pairing has made the two peaks a focal point of local mythology and geological interest, though the current spate of eruptions is a powerful reminder of the volatile nature of these otherwise majestic mountains.

The volcanic activity of Mount Lewotobi Laki-Laki, despite its toll, continues to draw the attention of both scientists and locals alike. According to PVMBG, the volcano’s magma chamber has likely experienced significant pressure build-up, causing the recurring explosive events. Ongoing monitoring and further research are expected to yield insights into the precise mechanisms behind this eruption, as scientists analyze gas emissions, ash compositions, and seismic data.

Indonesia, a sprawling archipelago of over 17,000 islands, sits atop the Pacific “Ring of Fire”—an area of intense seismic and volcanic activity shaped by the tectonic interactions of the Pacific, Eurasian, and Indo-Australian plates. The country’s geography makes it highly susceptible to volcanic eruptions, earthquakes, and tsunamis. With 130 active volcanoes, Indonesia leads the world in volcanic activity, making events like the Lewotobi eruption a recurring challenge.

For Indonesia’s national government and local disaster response agencies, the Lewotobi eruption is a stark reminder of the ongoing need for robust emergency response systems. Enhanced disaster preparedness, coupled with scientific monitoring networks, have become essential in a country where such natural events are part of everyday life.

Beyond immediate risks to life and property, Mount Lewotobi Laki-Laki’s eruptions have also dealt a blow to the local economy, which relies heavily on agriculture and tourism. Volcanic ash has blanketed farmlands, jeopardizing crop yields and causing potential long-term soil degradation. Tourism, too, has been affected, as visitors stay away from Flores Island amid reports of the ongoing eruptions.

In addition to the economic impact, the environmental effects of volcanic ash dispersal are profound. Ash particles can contaminate water supplies, damage vegetation, and disrupt local ecosystems. For residents reliant on agriculture, the ash fall presents a multifaceted challenge, impacting everything from crop growth to livestock health.

In light of these significant challenges, Indonesian authorities have mobilized national and local resources to support the impacted communities. Health teams have been dispatched to evacuation centers to monitor the respiratory health of evacuees, especially given the thick ash clouds that continue to settle over wide areas. Medical personnel are on high alert for respiratory ailments, skin irritation, and eye problems that can arise from prolonged ash exposure.

At the same time, the Indonesian government has coordinated with the national army and police force to assist in evacuations and logistics. Relief organizations have stepped in to provide food, water, and essential supplies to those temporarily housed in shelters. Educational programs are also underway, teaching evacuees how to protect themselves from ash exposure and prepare for the possibility of additional evacuations.

While the exact duration of Mount Lewotobi Laki-Laki’s current eruption cycle remains unknown, the recurring explosions emphasize the necessity of long-term planning for regional resilience. The Indonesian government has pledged to enhance early-warning systems across the nation’s volcanic hotspots, drawing from lessons learned during recent eruptions at Mount Semeru and Mount Merapi. The goal is to refine predictive capabilities and ensure that at-risk communities have sufficient time to prepare for, and potentially evacuate from, impending eruptions.

Community resilience is also taking shape through education initiatives that train residents to respond swiftly and effectively during natural disasters. The National Disaster Mitigation Agency, in collaboration with local government bodies, has rolled out disaster-preparedness programs in schools and community centers, teaching citizens how to interpret warning signs and take protective measures.