Health Systems of Dozens of Countries Near 'Total Collapse' Due to Oxygen Shortages

Persistent inequalities in healthcare have left many health systems in the Global South on the brink of collapse as Covid-19 case numbers climb and vaccinations lag, according to a new study of countries that are lacking oxygen supplies for patients.

The Bureau of Investigative Journalism analyzed data from the Every Breath Counts Coalition, the NGO Path, and the Clinton Health Access Initiative (CHAI) and found that at least 19 countries need more than 13 million liquid gallons of oxygen per day to cope with rising case numbers.

India, Nepal, Argentina, Colombia, Pakistan, South Africa, and Iran are among the countries most at risk, the report showed, with fewer than one in 10 people having been vaccinated and the need for oxygen supplies rising more than 20% since March.

"We could see the total collapse of health systems, especially in countries with very fragile systems," said Robert Matiru, chair of the World Health Organization's Covid-19 Oxygen Emergency Task Force.

"Medical oxygen has been around for over a century yet countries are struggling to prevent Covid patients from suffocating," said Dr. Paul Sonenthal, a critical care physician and instructor at Harvard Medical School. "It's a tragic example of the violence of health inequity and demands action."

The task force was assembled in February as WHO announced that $90 million was needed immediately to secure oxygen supplies in up to 20 low- and middle-income countries.

"Medical oxygen has been around for over a century yet countries are struggling to prevent Covid patients from suffocating. It's a tragic example of the violence of health inequity and demands action."
--Dr. Paul Sonenthal, Harvard Medical School

At the time, Brazil's Covid-19 crisis was being called "a warning to the whole world" as it faced an especially contagious variant of the coronavirus and hospitals in the northern state of Amazonas ran out of oxygen, forcing healthcare workers to allow some patients to suffocate while they saved others.

"The situation last year, and again in January this year in Brazil and Peru, should have been the wake up call," said Leith Greenslade, coordinator of the Every Breath Counts Coalition. "But the world did not wake up."

"We should have known India would happen after seeing what happened in Latin America," she added, referring to India's current Covid-19 outbreak, putting the country at the epicenter of the pandemic with more than 300,000 deaths. "And now looking at Asia, we should know this will happen in some of the big cities in Africa."

India is currently reporting an average of 4,000 deaths per day, while several countries in South America including Uruguay, Argentina, and Chile are reporting the highest new rates of infection in the world.

According to the Bureau of Investigative Journalism, emergency funding for oxygen is not reaching countries in need quickly enough, leading some governments to order liquid oxygen producers to divert their supply to fulfill medical needs instead of sending it to industrial clients.

"We have to ask a very critical question: Why such an essential resource as oxygen is locked up in mining, steel, oil, and gas when the poor public hospital system can't provide enough to keep babies, adults and the elderly alive," Greenslade said. "If oxygen capacity is there for mining companies to extract, the capacity must be there for the health system to save lives."

In Nepal, the Bureau reported, healthcare workers lack not only liquid oxygen but also canisters in which to store and transport it to patients.

"They can't access fast financing from the global players that can translate into product in-country quickly," Greenslade said. "Now, if we had an emergency financing, we could immediately negotiate directly with cylinder makers to buy those cylinders, and transport them into Nepal within days."

Oxygen supplies were low in several of the countries in need prior to the pandemic, and Greenslade called on health ministries and global policymakers to ensure the Global South is better prepared if another respiratory public health crisis emerges.

"Countries must do what they need to do to prepare for the next one," she told the Bureau. "Scientists are saying this is not the first, and it may not be the worst."