It’s a dizzying number. In 2024, 4.9 million children will die before reaching their fifth birthday, according to a new UNICEF report. If we look more closely, the birth lottery remains relentless: the vast majority of these deaths still occur in sub-Saharan Africa and South Asia, where growing up in good health is still far from being a given.
The causes are sadly known: complications linked to prematurity, problems during childbirth, pneumonia, diarrhea, malaria, acute malnutrition. So many pathologies for which there are already simple and inexpensive treatments or interventions, provided you have access to a minimal health system. “No child should die from diseases we know how to prevent, but we see worrying signs that progress on child survival is slowing”warns Catherine Russell, director general of Unicef in the pages of the Guardian.
Since 2000, mortality among children under 5 has been reduced by more than half globally, but the momentum is clearly slowing. According to the report, the rate of decline in these deaths has fallen by more than 60% since 2015: the curve is still going down, but much too slowly to hope to reach the objective set for 2030, that of putting an end to preventable child deaths.
The conclusions of the UN agency are clear: the question of financing is central. Cuts in international aid and health budgets weaken already exhausted systems: when money is lacking, it is first of all vaccination campaigns, the distribution of impregnated mosquito nets against malaria or child nutrition programs which are reduced or suspended.
A health system on its last legs
Added to this budgetary pressure are other aggravating factors such as armed conflicts, chronic poverty, the collapse of infrastructure, or the effects of climate change. In countries like Somalia or Pakistan, episodes of drought and floods aggravate malnutrition, which becomes both a direct cause of death and a silent accomplice: a weakened child no longer has the reserves to survive an otherwise benign infection.
On the ground, NGOs describe caregivers ordered to work miracles with almost nothing. “Aid cuts lead to an increase in preventable deaths, threatening the continuity of vital services just as need increases. “This reverses decades of progress”summarizes one of the organizations interviewed. It’s not just a question of medicines: each health center closure deprives a village of pregnancy monitoring, nutritional advice or rapid treatment of an infection.
However, the levers are well identified: strengthening basic care, training staff in obstetrics and neonatology, guaranteeing stocks of oral rehydration salts, essential antibiotics and access to safe drinking water would be enough to save hundreds of thousands of lives each year, insist the WHO and Unicef. The examples of countries which have reduced infant mortality in a few years thanks to strong political commitment show that this scourge is not inevitable.
The report is unambiguous. The international community has the tools, the know-how and the evidence that these strategies work, but a lack of political will and funding threatens to derail the progress made over the past two decades.
