By Joseph Chamie
PORTLAND, USA, Jan 7 2026 – While death is inevitable for everyone, the timing of “The Appointment in Samarra” varies significantly among and within populations. Fortunately, mortality levels of human populations have declined significantly worldwide in recent years, leading to increased survival rates and delayed appointments in Samarra.

For example, in the mid-20th century, life expectancies at birth for males and females were 45 and 48 years, respectively. Today, males and females have life expectancies at birth of 71 and 76 years, respectively, which is an increase of more than 25 years. Additionally, females generally have higher life expectancies than males across countries (Figure 1).

Source: United Nations.

Despite impressive global declines in mortality rates, life expectancies at birth vary significantly among countries. Currently, life expectancies at birth for males and females range from highs of about 82 and 87 years, respectively, in Japan and Italy, to lows of approximately 55 and 57 years, respectively, in Nigeria and the Central African Republic.

Inequities in life expectancies at birth persist across different age groups. For example, by the age of 65, country differences in life expectancy remain substantial. In Japan and Italy, life expectancies for males and females at age 65 are approximately 20 and 24 years, respectively. In contrast, the life expectancies for males and females at age 65 in Nigeria and the Central African Republic are about 12 and 13 years, respectively.

Similarly, infant mortality rates vary greatly among countries around the world. The mortality rates of infants range from lows of approximately 2 deaths per 1,000 births in Japan and Italy to highs over 30 times greater, with about 68 deaths per 1,000 births in Nigeria and the Central African Republic.

Longer life expectancies for the world’s population have also led to an increase in the number of centenarians.

In 1950, there were nearly 15,000 centenarians worldwide, making up 0.001% of the global population. Today, there are approximately 630,000 centenarians, accounting for close to 0.01% of the world’s population. By 2050, the number of centenarians is projected to reach 2.6 million, representing around 0.03% of the world’s population (Figure 2).

Source: United Nations.

There are many important factors that influence when and how the appointment in Samarra will occur. These factors include place of birth, residence, sex, socio-economic status, housing, healthcare, nutrition, diet, education, friends, exercise, genetics, disease prevalence, economic stability, public health, injuries, mental health, environmental conditions, political stability, human rights, social support, sanitation, substance use, lifestyle choices, parenting, personal habits, poverty, and violence (Table 1).

Declines in fertility rates have followed mortality rate declines, commonly described as the demographic transition. The fertility rate of the world’s population has fallen from a high of about 5.3 births per woman in the early 1960s to 2.2 births per woman today.

More than half of all countries and areas worldwide have a fertility rate below the replacement level of 2.1 births per woman. In many of these countries, deaths outnumber births, resulting in negative rates of population growth.

For example, in China, deaths began outnumbering births about five years ago. This trend is expected to continue for the rest of the 21st century, leading to population decline and the demographic ageing of the Chinese population.

The timing and circumstances of appointments in Samarra differ among the populations of more developed and less developed countries. People in the latter group are more likely to die from communicable diseases than from noncommunicable diseases, which are chronic conditions typically associated with older, aging populations and lifestyle factors.

Among more developed countries, major causes of death include heart disease, cancer, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. Other leading causes are Alzheimer’s and other dementia, tuberculosis, diarrheal diseases, HIV/AIDS, and external causes and injuries.

Currently, life expectancies at birth for males and females range from highs of about 82 and 87 years, respectively, in Japan and Italy, to lows of approximately 55 and 57 years, respectively, in Nigeria and the Central African Republic

Additionally, in many countries, cancer has replaced heart disease as the leading cause of death. The most common cancers are breast, lung, colon, rectum, and prostate cancer.

Approximately a third of cancer deaths are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity. Air pollution is also an important risk factor for lung cancer. Many cancers can be cured if detected early and treated effectively.

In many less developed countries, major causes of death include lower respiratory diseases, stroke, heart disease, malaria, and pre-term birth conditions. Other important causes include diarrheal diseases, tuberculosis, birth trauma, and HIV/AIDS.

Another major cause of death in recent years has been the coronavirus or COVID-19. The World Health Organization declared it a global pandemic on 11 March 2020, and it ended in May 2023, but remains an ongoing health threat. The pandemic resulted in over 7 million officially reported deaths worldwide, but the estimated excess morality is significantly higher, ranging between 18 and 35 million.

A crucial factor influencing the timing of appointments in Samarra is the availability of universal health coverage. According to the World Health Organization, universal health coverage ensures that every individual in a country has access to a wide range of health services, from emergency treatments to palliative care, without facing financial difficulties.

As of 2024, 73 out of the 195 countries worldwide were reported to offer some form of universal health coverage, which covers around two-thirds of the global population of 8.2 billion.

Among more developed nations, the United States stands out as a notable exception for not providing universal health care to all its citizens. In 2024, private health insurance coverage remained more prevalent than public coverage, with 66% of the U.S. population being covered. Additionally, the U.S. was noted for having the highest healthcare spending figure per capita in the world.

A significant debate surrounding the appointments in Samarra revolves around the right to die or medically assisted suicide. The differing perspectives about assisted suicide focus on the balance between individual autonomy and the sanctity of life.

Some believe that individuals experiencing unbearable suffering, often due to a terminal illness or incurable condition, should have the legal right and control to decide on medically assisted suicide or voluntary euthanasia. In contrast, others argue that assisted suicide devalues human life and opens the door to potential abuse. They also emphasize the importance of palliative care for those facing illness or personal struggles.

Medically assisted suicide is legal under specific circumstances in a limited number of countries. Those places include Australia, Austria. Belgium, Canada, Colombia, Ecuador, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, and twelve states in the United States.

In order to be eligible for medical assistance in dying, an individual typically must meet certain criteria. These criteria may include having a terminal illness or disability, being of sound mind, expressing a voluntary desire to die, and being capable of self-administering the lethal dose.

While the appointment in Samarra is inevitable for every human being, the timing of when this appointment will occur remains a topic of debate among the scientific community.

Some believe that there is a fixed limit to human life span, largely attributed to the gradual processes of biological ageing. They stress the implausibility of radical life extension for humans in the 21st century.

On the other hand, some argue that there is no conclusive evidence that the limit of human life span has been reached. The oldest supercentenarian on record, Jeanne Calment of France, lived to be 122 years and 164 days. Some experts predict that this current record of 122 years will be surpassed by the end of the 21st century, possibly even reaching 130 years.

In conclusion, the mortality rates of human populations have decreased globally in recent years, leading to improved chances of survival, longer life expectancies, and a growing number of centenarians. However, the timing and circumstances of the inevitable appointment in Samarra vary, with populations in more developed countries continuing to experience lower death rates and longer life expectancies compared to populations in less developed countries.

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division, and author of many publications on population matters.

By Sennen Hounton and Lydia Zigomo
UNITED NATIONS, Jan 7 2026 – New estimates show that violence against women and girls remains one of the most pervasive human rights violations in the world – and that one of its fastest-growing frontiers is the digital space.

Technology-facilitated gender-based violence includes online harassment, cyberstalking, image-based abuse, deepfake exploitation and coordinated digital attacks, and all of these are proliferating.

Anonymous accounts, weak reporting systems, and limited legal consequences have enabled perpetrators to weaponize technology to shame, silence, and violate women and girls at unprecedented scale and speed.

Africa is no exception.

Across the continent, disturbing patterns are emerging: Girls are facing cyberbullying and sextortion. Women leaders and human rights defenders are disproportionately targeted through coordinated online abuse designed to intimidate them out of public life.

During elections, women in public roles report harassment, smear campaigns and doxxing – tactics meant to silence civic participation.

In humanitarian settings – from the Sahel to the Lake Chad Basin to Sudan and the Democratic Republic of the Congo – displaced women and girls rely on digital tools to stay connected and access essential services.

Yet these same tools expose them to surveillance, extortion, blackmail and exploitation.

In conflict contexts, online threats have escalated into offline consequences – including intimidation, detention and physical violence.

Despite the scale of the problem, most cases remain invisible because technology companies, justice systems and communities have not kept pace. Reporting mechanisms are often ineffective.

Digital safety is rarely taught in schools or homes. Survivors face retaliation and victim-blaming. Perpetrators, and the platforms that enable them, are almost never held accountable.

The consequences are severe. Technology-facilitated violence impacts mental health, restricts mobility, destroys livelihoods and erodes confidence. “This virtual world can have real emotional impacts. It’s not enough to say ignore it or log off,” a 24-year-old woman in Chad told UNFPA.

Other young women in Africa also describe witnessing or experiencing harms with real-world impacts: “My page was hacked, I was forced to do things against my will,” a 31-year-old woman from Liberia said.

“Someone had published naked photos and videos of me in our local village Facebook group,” a young woman in Kenya shared. “I gathered the courage and went to a police station to report the incident. The officers I spoke to first admonished me and told me that this was not a criminal case, but rather a case of indecent behaviour on my part.”

In aggregate, these harms are reshaping the digital public sphere in ways that exclude women and girls.

When girls abandon online learning for fear their images may be misused, or when women delete their accounts to escape harassment, societies lose leadership, innovation and the voices essential to progress.

Gender equality cannot advance when half the population is pushed out of digital spaces.

That is why UNFPA and partners convened the first-ever Africa Symposium on Technology-facilitated Gender-based Violence in November, convening leaders in digital rights and gender-based violence prevention and response. It is time to build alliances and explore solutions. Africa is home to multiple hubs of technological innovation, and to the world’s youngest population.

As the digital divide slowly closes, we must ensure that the technology being adopted is safe, private and secure, and does not reinforce or amplify existing gender and social inequalities.

Symposium attendees recognized the need for a bold, coordinated response, one that follows the same principles that guide all efforts to end gender-based violence: dignity, consent, confidentiality, privacy, and survivor-centered care.

We must create a world where “African innovators lead the way in designing digital ecosystems that are safe, ecosystems that are inclusive and empowering for all, and in particular for women and marginalized communities,” said Judy Karioko, from the International Research & Exchanges Board (IREX) in Kenya, at one of the Symposium’s sessions.

UNFPA is committed to making every space – physical or digital – safe for women and girls in all their diversity. Through the Making All Spaces Safe programme, supported by Global Affairs Canada, concrete action is being taken across Africa, including Benin, Ghana, Kenya and Tunisia, to integrate technology risks into efforts to end gender-based violence.

But no single institution can end digital violence alone. Governments, tech companies, educators, civil society, faith leaders, families – and every digital citizen – share responsibility.

The world’s future begins with Africa. As a region, and as a global community, we cannot wait. Because if we fail to make the online world safe, we fail to protect the future of girls, and the world growing up in the digital age.

Dr. Sennen Hounton is the UNFPA Regional Director for West and Central Africa, while Ms. Lydia Zigomo is the UNFPA Regional Director for East and Southern Africa

Source: Africa Renewal, United Nations

IPS UN Bureau

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By Ed Holt
BRATISLAVA, Jan 7 2026 – “It was an emergency caesarean section when the life of the pregnant woman was at risk. We did the operation with just flashlights and no water, and against a backdrop of constant explosions,” says Dr Oleksandr Zhelezniakov, Director of the Obstetrics Department at Kharkiv Regional Clinical Hospital, in eastern Ukraine.

He is recalling what he says was “one of the most difficult” medical procedures he has been involved in since the start of Russia’s full-scale invasion of his country.

But it was far from the only time he has had to work in extreme conditions while his city is pounded by Russian shelling. In fact, he says, it has become routine for him and his colleagues.

“The current reality is that, given we are in a frontline city, we work like this almost every day, because the alarms never stop and we hear explosions almost every day,” he tells IPS.

“You just do what you have to do to save a life, to save the future. In such moments, you only think about saving a life. We work [in these conditions] because life must always prevail,” he says.

Staff look at the beginnings of construction of a bunkerised facility at Kharkiv City Multifunctional Hospital No. 25. Credit: UNFPA/Ukraine

Zhelezniakov’s hospital has, like many other medical facilities in Ukraine, been repeatedly attacked and damaged since the start of the war. The World Health Organisation (WHO) had documented more than 2,700 attacks on Ukrainian healthcare facilities since February 24, 2024.

These have included attacks on more than 80 maternal healthcare facilities – with devastating consequences for maternal health, as recently released data has shown.

According to analysis by the United Nations Population Fund (UNFPA) released in December, there has been a sharp rise in the risk of dying in pregnancy or childbirth in Ukraine as the conflict grinds on.

The agency says repeated strikes on hospitals and the breakdown of essential services are forcing women to give birth in increasingly dangerous conditions, and health workers have warned that a combination of violence, chronic stress, displacement and widespread disruption of maternity care is driving a surge in pregnancy complications and preventable deaths.

Its analysis of national data shows a 37-percent increase in the maternal mortality rate from 2023 to 2024 – the most recent full year of national data available. In 2023, Ukraine recorded 18.9 maternal deaths per 100,000 live births. In 2024, that figure rose to 25.9. The organisation says most of these are preventable deaths, reflecting a health system operating under extreme strain.

It said it had also seen sharp increases in severe pregnancy and childbirth complications. Uterine ruptures — among the most dangerous obstetric emergencies — have risen by 44 per cent. Hypertensive disorders of pregnancy have increased by more than 12 per cent, while severe postpartum haemorrhage has risen by nearly 9 per cent – from 2023 to 2024. Delays in accessing care, stress, displacement and disrupted referral pathways are key contributing factors.

Meanwhile, the situation in frontline regions is particularly acute. In Kherson, premature births are almost double the national average, and the region has the highest stillbirth rate in the country, according to UNFPA.

It cites contributing factors including stress, insecurity and difficulties in accessing care, which can lead to preterm labour and premature rupture of membranes.

Another indicator of system strain is the Caesarean section rate. Nationally, the rate now exceeds 28 per cent, already above recommended levels. In frontline regions, the figures are among the highest in Europe: 46 per cent in Kherson and approximately 32 per cent in Odesa, Zaporizhzhia and Kharkiv. These high rates often reflect the need for doctors and women to time deliveries around short windows of relative safety and can additionally show an increased pregnancy complication rate that requires surgical intervention, according to UNFPA officials.

“Attacks [on healthcare, including maternity and neonatal facilities] have had measurable and severe consequences for maternal health. Ukraine is entering another winter under conditions that sharply increase risks for pregnant women, newborns and the health workers who care for them,” Isaac Hurskin, Head of Communications, UNFPA in Ukraine, told IPS.

In early December, a maternity hospital in Kherson, a facility supported by UNFPA, was struck by artillery fire. During the strike, hospital staff moved women in labour and newborns into a bunkered maternity ward—one of many such facilities constructed by the government with help from groups like UNFPA to protect mothers and babies during active hostilities.

While everyone survived the attack and a baby girl was born in the bunker during the shelling, Hurskin said it was “a stark illustration of the conditions under which pregnancy and childbirth are now taking place — conditions no woman or health worker should ever have to face”.

But the devastation wrought by the war in Ukraine is also impacting wider reproductive health.

IPS has spoken to women in Ukraine who have admitted they are avoiding getting pregnant because of concerns about their ability to access maternal healthcare safely but also the conditions in which they may have to raise an infant.

“Women in conflict-affected areas have specific reproductive needs. It is very hard to meet them when a maternity hospital gets bombed on a regular basis, or when energy infrastructure is targeted, limiting the functionality of hospitals and forcing pregnant women to unequipped hospital shelters. A woman considering getting pregnant needs to make a decision based on these factors – whether a hospital is safe, whether she can have access to services, and whether she is able to care for the child afterwards, with no electricity, heating, or water at home,” Uliana Poltavets, International Advocacy and Ukraine Program Coordinator at Physicians for Human Rights (PHR), told IPS.

“This is a trend which is being observed,” added Zhelezniakov. “Women fear not only for their lives and the lives of their unborn children during childbirth under shelling but also an uncertain future—a lack of safe housing, work, and normal conditions for raising a child. This is a rational fear in the irrational conditions of war. It is one of the reasons for the sharp decline in the birth rate.”

But he added that conversely, the effects of the war were impacting women’s ability to conceive.

“Chronic stress, high cortisol levels, anxiety, and sleep disorders directly affect hormonal balance and reproductive function. Constant stress also leads to hormonal imbalances (dysfunction of the hypothalamic-pituitary-ovarian axis). This causes an increase in cases of secondary infertility, premature ovarian failure, and endometriosis. We are already seeing an increase in the number of pathological menopauses in young women,” he said.

These threats to fertility and maternal health come at a time when Ukraine is facing a demographic crisis.

According to UNFPA, since 2014, when Russia illegally annexed Crimea and supported separatist paramilitary movements in eastern Ukraine, the country has lost an estimated 10 million people through displacement, mortality and outward migration. Fertility has fallen to below one child per woman — one of the lowest rates globally.

It says that rising maternal deaths, increasing complications and pervasive uncertainty about the safety of childbirth reinforce one another, with long-term consequences for families, communities and national recovery.

“This is not only a humanitarian emergency. It is a demographic crisis with implications that will extend far beyond the end of hostilities. Protecting maternal health is central to Ukraine’s long-term recovery and future stability,” said Hurskin.

Indeed, examples from other recent conflicts where there has been widescale destruction of healthcare have shown the long-term effects of war on maternal and reproductive healthcare long after they have finished, from problems with rebuilding damaged and destroyed facilities, ongoing displacement, and continued shortages of medical staff just some of the barriers to women being able to access services.

“Look at Syria, for example. The healthcare system is being built back up, there is rebuilding of facilities, things are improving, but it will take decades to get back to where it was before. And maternal healthcare tends to be deprioritised both during and after a conflict – resources tend to go to other areas such as emergency and trauma care. Women in Syria will have problems with accessing maternal healthcare for years and years to come,” an expert on healthcare in war zones working for an international human rights group, who spoke on condition of anonymity for security reasons, told IPS.

Zhelezniakov admits that a worsening of the demographic crisis in Ukraine is inevitable.

“The expectation is that it will get worse. The destruction of the maternal health care system only exacerbates existing problems caused by the war: the migration of women and children abroad, loss of life, economic instability, and psychological pressure,” he says.

But he adds that even now measures can be taken to improve maternal healthcare, including strengthening primary care, improving digitalisation (e-health systems), investment in prevention, mental health support programmes, environmental improvement, legislative regulation, and raising awareness of reproductive health to reduce mortality and disability, among others.

Developing international cooperation by creating “medical hubs” in relatively safe regions with the support of international partners, such as UNFPA and WHO, to ensure services, would also help.

“Even during active hostilities, we can and must work to adapt the system,” he says.

He also vows that, no matter what happens, he and other medical staff will not stop their work, recalling the emergency caesarean section performed by flashlight as shells rained down on Kharkiv.

“The birth of a child in such conditions is always a miracle and a powerful motivator to continue working, despite everything,” he says.

IPS UN Bureau Report

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