Background - The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods - We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings - Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation - The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
WOS: 000471758500010 ; PubMed ID: 31209238 ; The effectiveness of most cancer targeted therapies is short-lived. Tumors often develop resistance that might be overcome with drug combinations. However, the number of possible combinations is vast, necessitating data-driven approaches to find optimal patient-specific treatments. Here we report AstraZeneca's large drug combination dataset, consisting of 11,576 experiments from 910 combinations across 85 molecularly characterized cancer cell lines, and results of a DREAM Challenge to evaluate computational strategies for predicting synergistic drug pairs and biomarkers. 160 teams participated to provide a comprehensive methodological development and benchmarking. Winning methods incorporate prior knowledge of drug-target interactions. Synergy is predicted with an accuracy matching biological replicates for >60% of combinations. However, 20% of drug combinations are poorly predicted by all methods. Genomic rationale for synergy predictions are identified, including ADAM17 inhibitor antagonism when combined with PIK3CB/D inhibition contrasting to synergy when combined with other PI3K-pathway inhibitors in PIK3CA mutant cells. ; AstraZenecaAstraZeneca; European Union Horizon 2020 research [668858 PrECISE]; Joint Research Center for Computational Biomedicine (Bayer AG); National Institute for Health Research (NIHR) Sheffield Biomedical Research Center, Premium Postdoctoral Fellowship Program of the Hungarian Academy of Sciences; Wellcome TrustWellcome Trust [102696, 206194] ; We thank the Genomics of Drug Sensitivity in Cancer and COSMIC teams at the Wellcome Trust Sanger Institute for help with the preparation of the molecular data, Denes Turei for help with Omnipath, and Katjusa Koler for help with matching drug names across combination screens. We thank AstraZeneca for funding and provision of data to the DREAM Consortium to run the challenge, and funding from the European Union Horizon 2020 research (under grant agreement No 668858 PrECISE to J.S.R.), the Joint Research Center for Computational Biomedicine (which is partially funded by Bayer AG) to J.S.R., National Institute for Health Research (NIHR) Sheffield Biomedical Research Center, Premium Postdoctoral Fellowship Program of the Hungarian Academy of Sciences. M.G lab is supported by Wellcome Trust (102696 and 206194).
The effectiveness of most cancer targeted therapies is short-lived. Tumors often develop resistance that might be overcome with drug combinations. However, the number of possible combinations is vast, necessitating data-driven approaches to find optimal patient-specific treatments. Here we report AstraZeneca's large drug combination dataset, consisting of 11,576 experiments from 910 combinations across 85 molecularly characterized cancer cell lines, and results of a DREAM Challenge to evaluate computational strategies for predicting synergistic drug pairs and biomarkers. 160 teams participated to provide a comprehensive methodological development and benchmarking. Winning methods incorporate prior knowledge of drug-target interactions. Synergy is predicted with an accuracy matching biological replicates for >60% of combinations. However, 20% of drug combinations are poorly predicted by all methods. Genomic rationale for synergy predictions are identified, including ADAM17 inhibitor antagonism when combined with PIK3CB/D inhibition contrasting to synergy when combined with other PI3K-pathway inhibitors in PIK3CA mutant cells. ; AstraZeneca ; European Union Horizon 2020 research [668858 PrECISE] ; Joint Research Center for Computational Biomedicine (Bayer AG) ; National Institute for Health Research (NIHR) Sheffield Biomedical Research Center, Premium Postdoctoral Fellowship Program of the Hungarian Academy of Sciences ; Wellcome Trust [102696, 206194] ; We thank the Genomics of Drug Sensitivity in Cancer and COSMIC teams at the Wellcome Trust Sanger Institute for help with the preparation of the molecular data, Denes Turei for help with Omnipath, and Katjusa Koler for help with matching drug names across combination screens. We thank AstraZeneca for funding and provision of data to the DREAM Consortium to run the challenge, and funding from the European Union Horizon 2020 research (under grant agreement No 668858 PrECISE to J.S.R.), the Joint Research Center for Computational Biomedicine (which is partially funded by Bayer AG) to J.S.R., National Institute for Health Research (NIHR) Sheffield Biomedical Research Center, Premium Postdoctoral Fellowship Program of the Hungarian Academy of Sciences. M.G lab is supported by Wellcome Trust (102696 and 206194).
The effectiveness of most cancer targeted therapies is short-lived. Tumors often develop resistance that might be overcome with drug combinations. However, the number of possible combinations is vast, necessitating data-driven approaches to find optimal patient-specific treatments. Here we report AstraZeneca's large drug combination dataset, consisting of 11,576 experiments from 910 combinations across 85 molecularly characterized cancer cell lines, and results of a DREAM Challenge to evaluate computational strategies for predicting synergistic drug pairs and biomarkers. 160 teams participated to provide a comprehensive methodological development and benchmarking. Winning methods incorporate prior knowledge of drug-target interactions. Synergy is predicted with an accuracy matching biological replicates for >60% of combinations. However, 20% of drug combinations are poorly predicted by all methods. Genomic rationale for synergy predictions are identified, including ADAM17 inhibitor antagonism when combined with PIK3CB/D inhibition contrasting to synergy when combined with other PI3K-pathway inhibitors in PIK3CA mutant cells. ; We thank the Genomics of Drug Sensitivity in Cancer and COSMIC teams at the Wellcome Trust Sanger Institute for help with the preparation of the molecular data, Denes Turei for help with Omnipath, and Katjusa Koler for help with matching drug names across combination screens. We thank AstraZeneca for funding and provision of data to the DREAM Consortium to run the challenge, and funding from the European Union Horizon 2020 research (under grant agreement No 668858 PrECISE to J.S.R.), the Joint Research Center for Computational Biomedicine (which is partially funded by Bayer AG) to J.S.R., National Institute for Health Research (NIHR) Sheffield Biomedical Research Center, Premium Postdoctoral Fellowship Program of the Hungarian Academy of Sciences. M.G lab is supported by Wellcome Trust (102696 and 206194).
Motivation: The BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity within and amongst assemblages using a broad range of metrics. BioTIME is being developed as a community-led open-source database of biodiversity time series. Our goal is to accelerate and facilitate quantitative analysis of temporal patterns of biodiversity in the Anthropocene. Main types of variables included: The database contains 8,777,413 species abundance records, from assemblages consistently sampled for a minimum of 2 years, which need not necessarily be consecutive. In addition, the database contains metadata relating to sampling methodology and contextual information about each record. Spatial location and grain: BioTIME is a global database of 547,161 unique sampling locations spanning the marine, freshwater and terrestrial realms. Grain size varies across datasets from 0.0000000158 km(2) (158 cm(2)) to 100 km(2) (1,000,000,000,000 cm(2)). Time period and grainBio: TIME records span from 1874 to 2016. The minimal temporal grain across all datasets in BioTIME is a year. Major taxa and level of measurement: BioTIME includes data from 44,440 species across the plant and animal kingdoms, ranging from plants, plankton and terrestrial invertebrates to small and large vertebrates. ; European Research Council; EU [AdG-250189, PoC-727440, ERC-SyG-2013-610028]; Natural Environmental Research Council [NE/L002531/1]; National Science Foundation [DEB-1237733, DEB-1456729, 9714103, 0632263, 0856516, 1432277, DEB 9705814, BSR-8811902, DEB 9411973, DEB 0080538, DEB 0218039, DEB 0620910, DEB 0963447, DEB-1546686, DEB-129764]; National Science Foundation (LTER) [DEB-1235828, DEB-1440297, DBI-0620409, DEB-9910514, DEB-1237517, OCE-0417412, OCE-1026851, OCE-1236905, OCE-1637396, DEB 1440409, DEB-0832652, DEB-0936498, DEB-0620652, DEB-1234162, DEB-0823293, OCE-9982105, OCE-0620276, OCE-1232779]; Fundacao para a Ciencia e Tecnologia [POPH/FSE SFRH/BD/90469/2012, SFRH/BD/84030/2012, PTDC/BIA-BIC/111184/2009]; Ciencia sem Fronteiras/CAPES [1091/13-1]; Instituto Milenio de Oceanografia [IC120019]; ARC Centre of Excellence [CE0561432]; NSERC Canada; CONICYT/FONDECYT [1160026, ICM PO5-002, 11110351, 1151094, 1070808, 1130511]; RSF [14-50-00029]; Gordon and Betty Moore Foundation [GBMF4563]; Catalan Government; Marie Curie Individual Fellowship [QLK5-CT2002-51518, MERG-CT-2004-022065]; CNPq [306170/2015-9, 475434/2010-2, 403809/2012-6, 561897/2010, 306595-2014-1]; FAPESP (Sao Paulo Research Foundation) [2015/10714-6, 2015/06743-0, 2008/10049-9, 2013/50714-0, 1999/09635-0 e 2013/50718-5]; EU CLIMOOR [ENV4-CT97-0694]; VULCAN [EVK2-CT2000-00094]; DFG [120/10-2]; Polar Continental Shelf Program; CENPES - PETROBRAS; FAPERJ [E-26/110.114/ 2013]; German Academic Exchange Service; New Zealand Department of Conservation; Wellcome Trust [105621/Z/14/Z]; Smithsonian Atherton Seidell Fund; Botanic Gardens and Parks Authority; Research Council of Norway; Conselleria de Innovacio, Hisenda i Economia; Yukon Government Herschel Island-Qikiqtaruk Territorial Park; UK Natural Environment Research Council ShrubTundra Grant [NE/M016323/1]; IPY; Memorial University; ArcticNet; Netherlands Organization for Scientific Research in the Tropics NWO [W84-194]; Ciencias sem Fronteiras and Coordenacao de Pessoal de Nivel Superior (CAPES, Brazil) [1091/13-1]; U.S. Fish and Wildlife Service/State Wildlife federal grant [T-15]; Australian Research Council Centre of Excellence for Coral Reef Studies [CE140100020]; Australian Research Council Future Fellowship [FT110100609]; University of Lodz; NSF DEB [1353139]; Catalan Government fellowships (DURSI) [1998FI-00596, 2001BEAI200208]; MECD Post-doctoral fellowship [EX2002-0022]; FONDECYT [1141037]; FONDAP [15150003]; [SFRH/BD/80488/2011]; [PD/BD/52597/2014]; [REN2000-0278/CCI]; [REN2001-003/GLO]; [CGL2016-79835-P]; [AGAUR SGR-2014453]; [SGR-2017-1005]; [FCT - SFRH / BPD / 82259 / 2011]; [OCE 95-21184]; [OCE-0099226]; [OCE 03-5234]; [OCE-0623874]; [OCE-1031061]; [OCE-1336206]; [DEB-1354563]; [OPP-1440435] ; 12 month embargo; published online: 24 July 2018 ; This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
We introduce the AusTraits database - a compilation of values of plant traits for taxa in the Australian flora (hereafter AusTraits). AusTraits synthesises data on 448 traits across 28,640 taxa from field campaigns, published literature, taxonomic monographs, and individual taxon descriptions. Traits vary in scope from physiological measures of performance (e.g. photosynthetic gas exchange, water-use efficiency) to morphological attributes (e.g. leaf area, seed mass, plant height) which link to aspects of ecological variation. AusTraits contains curated and harmonised individual- and species-level measurements coupled to, where available, contextual information on site properties and experimental conditions. This article provides information on version 3.0.2 of AusTraits which contains data for 997,808 trait-by-taxon combinations. We envision AusTraits as an ongoing collaborative initiative for easily archiving and sharing trait data, which also provides a template for other national or regional initiatives globally to fill persistent gaps in trait knowledge. ; Funding Agencies|Australian Research CouncilAustralian Research Council [FT160100113, DE170100208, FT100100910]; National Collaborative Research Infrastructure Strategy (NCRIS)Australian GovernmentDepartment of Industry, Innovation and Science
BACKGROUND: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS: Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING: Bill & Melinda Gates Foundation. ; Bill & Melinda Gates Foundation ; Sí
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As famine looms in northern Gaza, the United Nations agency for Palestinian refugees is hurtling toward collapse."What I can say today is that we can run our operation until the end of May, whereas a month ago I had just the visibility for the next week or two weeks," Philippe Lazzarini, head of the U.N. Palestinian refugees agency (UNRWA), told reporters in Geneva last week, just days after Israel denied him entry into Gaza. "But that shows also how bad the financial situation of the organization is."The money crunch stems in part from a fateful U.S. decision. When Israel accused a dozen of UNRWA's 13,000 Gaza-based employees of facilitating the Oct. 7 attacks, American officials immediately paused funding for the organization pending an investigation. Many other top donors followed suit, leaving UNRWA scrambling to stay afloat.It's since become clear that Israel's accusations relied on less-than-definitive evidence. This revelation led most funders to turn the spigot back on. But the U.S., with its unusually deep pockets, is now banned from changing course. Less than two weeks ago, Congress passed a law blocking all funding for UNRWA until March 2025. The timing of this decision is nothing short of disastrous, according to Christopher Gunness, a former spokesperson for UNRWA. "Mass starvation has already set in, but without UNRWA it's impossible to even slow that down," Gunness said.Despite Israel's claims to the contrary, there is no way to replace UNRWA's role in Gaza, especially amid the largest Palestinian humanitarian crisis since Israel's war of independence, according to experts on humanitarian aid and UNRWA's history. Analysts also fear that potential interruptions in the agency's operations across the Middle East — including in war-torn Syria and crisis-riven Lebanon — could further undermine regional stability.A State Department spokesperson told RS that getting aid to Palestinians in Gaza is a "team effort." "[W]hile we will continue to provide funding to organizations like the World Food Programme [WFP], we will be looking to other donors to continue to provide critical funding to UNRWA as long as our funding remains paused," the spokesperson said in a statement.But groups like WFP simply don't have the capacity to fill the gap made by defunding UNRWA, according to a humanitarian working to get aid into Gaza who requested anonymity to prevent Israeli retribution."The work they do on a day-to-day basis, no one else does it, and you couldn't stand up an organization to do it," the humanitarian worker told RS. "There's literally no other place for [Gazans] to go."A love-hate relationshipDecades removed from its founding, it can be easy to forget where UNRWA came from. In a practical sense, it sprung from the need to get aid to 700,000 Palestinian refugees when it became clear that Israel would not let them return home after the 1948 war. But ideologically, UNRWA's story begins in the Tennessee Valley. In the 1930s, Congress launched a New Deal project known as the Tennessee Valley Authority (TVA). The TVA was a development initiative; it enlisted some of those hardest hit by the Great Depression and put them to work building dams, boosting crop yields, and bringing electricity to rural communities. It was, by most accounts, a rousing success. After the humanitarian disaster of the 1948 war, President Harry Truman hoped TVA chief Gordon Clapp could bring that success to the Middle East. With the support of the fledgling U.N., which had yet to establish an agency for refugees, Clapp visited the region in 1949 and became convinced that the Jordan Valley and other fertile areas in the Levant were ripe for TVA-style development. The U.N. General Assembly agreed, and the United Nations Relief and Works Agency was born. It didn't take long for "works" to disappear from the mission. Development projects sputtered, missing deadlines due to infighting among host countries and the refugees' general unwillingness to be relocated once more. "Most refugees refused to work," said Jalal al-Husseini, an expert on UNRWA's history and an associate researcher at the Insitut français du Proche Orient (Ifpo). "They wanted to go back home." Donor states also realized that large-scale public works are a good bit more expensive than more mundane relief projects. UNRWA's other activities — from schools to healthcare facilities and aid distribution — were far more successful. The organization provided much-needed help to the governments of Syria, Jordan, and Lebanon, each of which had little capacity to manage the refugee influx on their own. Besides a brief period in the early 1950s, Israel had little to do with UNRWA until 1967, when its forces routed Egypt, Jordan, and Syria in the provocatively named Six Day War. The conquest created a problem: As an occupying power, Israel was suddenly in charge of the welfare of millions of Palestinians. Tel Aviv quickly struck a deal with UNRWA to keep its operations going in the West Bank and Gaza Strip. Since the vast majority of UNRWA's local staff is Palestinian, the agency was "never really seen by Israel as a neutral and independent and impartial U.N. organization," according to Lex Takkenberg, a 30-year veteran of UNRWA who left the agency in 2019. "It started off with an explicit request by Israel for UNRWA to continue operating," Takkenberg said. "Since that time, there has sort of been a hatred-love relationship." Israel-Palestine watchers will recognize the pattern. Since the 1960s, Israel has periodically bemoaned the contents of UNRWA textbooks or accused staff of ties to Palestinian political groups (or terrorist organizations, in Tel Aviv's telling), drawing scrutiny from Western donors. UNRWA responds by excising objectionable content from courses and firing employees with apparent conflicts of interest. Over the years, these back-and-forths forced the agency to develop a comprehensive "neutrality framework" to keep politics out of its work. "Almost without exception, Israel never provided evidence" that employees had ties to groups like Hamas, Takkenberg recalled. But UNRWA would still usually fire them to protect the organization as a whole. "Then the Israelis would be back to business as usual," he said. "It never reached the point that [Israel] asked UNRWA to stop operations." In substance, the Oct. 7 allegations were the latest entry in this story. Israeli officials made bold allegations that UNRWA employees facilitated the attacks but have yet to provide evidence, even to U.N. investigators. But the reaction from donors was different. While the International Court of Justice has twice demanded a surge of aid into Gaza to avert disaster, most Western countries suspended support for the strip's leading relief group. Many have restarted their funding, but the U.S., United Kingdom, and Australia are still holding out. "Prohibiting the Biden administration from contributing to UNRWA creates a large gap in the Agency's annual operating budget," said William Deere, the head of UNRWA's Washington office. The shortfall "will make it harder for UNRWA to assist starving Gazans and potentially further weaken regional stability," Deere argued.UNRWA in crisisUNRWA is, of course, no stranger to crises. When Saddam Hussein's Iraq invaded Kuwait in 1990, Israel imposed a blanket curfew on the West Bank and Gaza, leaving many Palestinians with limited access to food. Quick mobilization from UNRWA prevented a bad situation from getting worse, according to Takkenberg."I organized massive food distributions during short periods that Israel lifted the curfew so that people could collect food from distribution points," he remembered.In the tumultuous period since, UNRWA has managed to stay afloat and provide aid across the Levant despite wars and a blockade in Gaza; a brutal conflict in Syria; and a protracted economic crisis in Lebanon.When President Donald Trump cut off funding in 2018, it came as a shock. "We found out that the Americans were not going to be giving us their money when the check did not arrive in the post," Gunness, the former spokesperson, recalled. This diplomatic equivalent of an Irish goodbye lit a fire under UNRWA staff, who put fundraising efforts into overdrive and filled the gap with pledges from wealthy Gulf countries. Even Israeli Prime Minister Benjamin Netanyahu reportedly backed the effort to avert "disaster" in Gaza.But all of these crises pale in comparison to the trial that the organization faces today. Gulf donors have so far failed to fill the gap left by the U.S. decision to cut off funding. At least 154 UNRWA employees have been killed since Oct. 7, and many of its facilities have been destroyed in the bombing. These direct attacks have been paired with an unprecedented Israeli PR effort to discredit the organization, all with the substantive backing of a Democratic U.S. president.Fringe Israeli activists have long argued that UNRWA is illegitimate in some fundamental sense, perpetuating a fanciful dream that Palestinians will eventually return home. Its existence, they argue, encourages false hope and prevents an end to the conflict. As Israel's political scene has lurched to the right, this view has become more popular. Now, multiple members of Netanyahu's cabinet are publicly opposed to UNRWA's very existence.Israel is now actively working to undermine UNRWA. In January, Finance Minister Bezalel Smotrich blocked a large shipment of U.S. aid in order to stop it from reaching UNRWA. The U.N. claims that Israeli officials are holding up visas for aid workers affiliated with the agency."UNRWA are part of the problem, and we will now stop working with them," an Israeli spokesperson said last week. "We are actively phasing out the use of UNRWA because they perpetuate the conflict rather than try and alleviate the conflict."Israeli opposition can only do so much to block the agency's work in the short term, according to Takkenberg, who noted that other groups are likely importing humanitarian aid in their own name and simply handing it off to UNRWA upon arrival. But that workaround has its limits as Israel allows only a trickle of aid to enter Gaza each day. There are currently as many as 30,000 trucks sitting in Egypt waiting to cross the border, according to a Jordanian official who spoke with NPR. "There are trucks that have been at the border for three months," the humanitarian worker told RS. "There's all sorts of crazy restrictions that make no sense, even from a security standpoint," they said, adding that they've had medical equipment and food confiscated during inspections.This has left UNRWA, and Gaza as a whole, on the verge of collapse. Israel and its Western backers will likely regret their role in bringing the crisis to this point, argued Gunness. "Any donor governments, especially those who are friends of Israel, who think that it's somehow in Israel's security interests to have millions of angry, hungry, radicalized, mourning, grief-stricken people living in appalling refugee camps and other circumstances on the doorstep of Israel, I wonder what planet they are living in," he said.
