Suddenly, we have arrived at a new geopolitical reality, at a dangerous crossroads: global health, human rights, international cooperation and humanitarian aid are under unprecedented pressure. Solo from EE UU. The unstable and complex international situation requires new forms of global cooperation or assumes the risk of fragmentation, which would undoubtedly affect both international stability and the well-being of societies. This is the moment to react with determination, to renew commitment between nations, by transforming dialogue and co-responsibility into pillars of a new world order that is fairer, more resilient and more sustainable.
We find ourselves at a point of no return: if we defend global health and cooperation now, we will lose another decade. Over the past 20 years, cooperation has saved, at worst, 92 million lives. In this scenario, development aid demonstrates every day that it serves a very concrete purpose, because it allows health programs to continue operating, essential services reach those who need them most and millions of people have a real opportunity to live with greater security and dignity. Its impact is undeniable. In the face of rhetoric that attempts to maintain the value of these efforts, the data demonstrates that cooperation only works and continues to have decisive power to build a more stable, more just and more humane future. Let’s now analyze the health of humanitarian aid in 2024.
Health in the World, objectives undermined
The first failure is visible in our path: the 2030 Agenda. We are only five years away from the 2030 deadline to achieve the Sustainable Development Goals (SDGs), and the results are heartbreaking. Only 18% of objectives are on track to be accomplished or achieved; The rest, at some point, show minimal progress or have stagnated or regressed. This opens up the possibility of acting with more ambition and correcting the trend while there is still time.
As far as our sector is concerned, SDG 3 – Ensure healthy lives and promote well-being – is even worse than the middle of the SDGs. Only 10% of your goals are on track to be achieved. Piensen considers this: despite improvements since 2000, every day continues to kill 712 women due to discomfort and childbirth problems, and 13,150 minors due to causes that, in the vast majority, are completely preventable. This is the face of inequality, which in the poorest countries makes the health assumption 70 times lower than that of high-income countries, and 31% of their public health spending depends directly on international cooperation (which has suffered a sharp decline due to Trump’s policies, and whose perverse example some countries will follow).
Our most pressing challenge, universal health coverage (UHC), has progressed slowly in recent years and still poses major challenges. Worldwide, 4.5 billion people lack access to basic services and 2.0 billion suffer financial hardship due to healthcare costs. Rich regions nearly double the coverage of regions like sub-Saharan Africa (84% versus 43%).
When vulnerable people become ill, the costs are catastrophic and make them even poorer. Thus, the vision of health continues to broaden and the One Health approach gains ground to integrate human, animal and planetary health. The climate crisis is now recognized as a health crisis, which invites us to replant our development model and lead profound transformations that allow us to create fairer, more resilient and more sustainable systems. With profound changes calling into question our consumerist model of infinite growth
The hemorrhage of international cooperation
When we need coordination and resources most, the international cooperation is in crisis. In 2024, Official Development Assistance (ODA) from the group of donor countries (CAD) will be reduced by $15.119 million compared to 2023, the largest absolute drop in the history of international cooperation. The trend is not improving: 2025 is predicted to be the worst year, with reductions of up to 17% in total AOD volume. Consequently, this situation also gives rise to new debates on how to strengthen international mechanisms and regain a collective commitment to more inclusive and effective development.
The most devastating blow came from the United States: a reduction of 50 billion dollars in one year, or 92% of their cooperation. By maintaining USAID savings, 14 million additional deaths could occur by 2030. Is this the price we are willing to pay for cutthroat policies? This is not an ideological debate, lives are being lost.
Over the past 20 years, USAID contributions have prevented 91.8 million deaths. Cooperation saved these lives. It is essential to repeat this clearly, because the anti-aid discourse of “It doesn’t fit”, “It doesn’t work”, “It’s an unnecessary expense”, has never been so obvious.
Spain, although it increased its ODA in 2024, follows a series of international commitments of 0.7% of gross national income (GNI) with 4,021 million euros. This is a figure that places us below the CAD (0.33%) and EU (0.47%) average. If we want to be a relevant actor, we must protect our funding with binding roadmaps and strong institutions like AECID – whose weight falls to 14.7% of total cooperation – and political commitment that does not depend on electoral cycles.
The message is clear: when cooperation weakens, on the ground we lose money: we lose trust, we lose legitimacy, we lose lives.
Health in Spanish cooperation, a crucial moment in its progress
Despite the overall increase in Public Development Assistance which exceeds 4 billion euros, the funds managed by the MAEUEC will decrease by 5% in 2024, while the AECID increases slightly (2.9%) to 590 million. However, the weight of the Agency within the Spanish cooperation group falls to 14.7%. This situation reflects a lack of coherence and institutional consolidation: the growth of ODA is not accompanied by a proportional strengthening of the structures responsible for its management.
Within this aid, health receives 276.7 million euros. A figure which is increasing, but which weighs less within the group. And that should worry us. Global health acts as a fabric that connects and protects the world, as an epidemic in another country, an extreme drought or a weakened health system can quickly turn into challenges that ultimately affect us.
This scenario also reminds us of the need to strengthen our own commitment, especially when the Ministry of Health only participates in health cooperation to the extent of only 0.46%. Most of the funding, 84%, comes from Exteriors and Hacienda. The positive is that it is supported by multilateral organizations like the WHO, GAVI or the Global Fund. The negative point is that if Spain really wants to influence, it must be present in the spaces where decisions are made.
Please note that “nuestra casa” -autonomous communities and ayuntamientos- continues to support a key element of this cooperation, even in times of budget cuts. One in six euros spent on global health comes from them. It’s much more than it seems.
The largest Spanish commitment for the next few years is a commitment of 315 million (2025-2027) to strengthen health systems around the world. A real opportunity to lead and protect lives.
Humanitarian action: unprecedented global humanitarian crisis
When conflicts and climate disasters occur, human suffering becomes unimaginable. By 2024, more than 323 million people will need humanitarian assistance. The war in Ukraine, the crisis which is ending in Sudan, the droughts in South Africa remind us how fragile we are. But the most catastrophic situation is unavoidable: the crisis in Gaza. With more than 69,000 deaths and the forced displacement of almost the entire population, the official declaration of Hambruna in August 2025 marks an unprecedented failure. This is the direct consequence of the use of the hambre as a weapon of war and the systematic obstruction of aid. Humanitarian access is not a political concession, it is a legal obligation!
The health sector in humanitarian action is going through a critical crisis. Funds will be reduced to $651 million in 2024. Attacks on health care have reached record levels: 3,623 cases in 2024. More than 1,100 medical facilities damaged or destroyed and more than 900 professionals murdered. Our hospitals have been transformed into targets, a blatant violation of international humanitarian law.
We must demand that governments take concrete steps to ensure compliance with these agreements. And let’s not forget invisible legacies. Violence, loss and displacement result in trauma that alters people’s identity and ability to face the future. Mental health and psychosocial support are not a luxury, but a right that must be integrated from the start into the humanitarian response, because without healing the invisible, there is no reconstruction possible.
We appeal for political volunteerism, because while global military spending has reached $2.7 billion in 2024, funds allocated to humanitarian appeals will only cover 50.48% of what is requested. We could have reached 0.7% of ODA if this increase had been allocated to cooperation!
Initiatives such as the WHO Pandemic Treaty are key to demonstrating the importance of globally coordinated action. Investing in health, education and environmental sustainability is not only a moral imperative, it is also an effective investment, with an annual return of around 20%.
Spain’s commitment, as seen at the Seville Conference, to engage in a renewed global health architecture and contribute €315 million by 2027, constitutes an important step. But the promise is not enough; we need sustained, consistent and equitable action.
The response from Médicos del Mundo and medicusmundi is clear: we cannot go back. Defending cooperation, protecting health systems and building strong multilateralism is not altruism: it is a strategy for collective survival. Every decision we make now can bring us closer to a world where the right to health becomes a reality for everyone.
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