I am thankful to have the opportunity to speak to the members. Before I outline the challenges facing us in the context of the SDGs, I remind everyone of the many positive strides made in the fight against global poverty in recent decades. We can be sure that the efforts of this committee and the agencies represented by Dóchas have been part of that success. Between 2015 and 2018, for example, poverty reduction continued its historical decline, with the extreme poverty rate falling from 10.1% to 8.6%. This means the number of people living on less than $1.90 daily fell from almost 750 million to 650 million in those three years. In the last 20 years, gains have also been made in maternal and child health, with the global maternal mortality ratio, MMR, and under-five mortality rate falling by nearly 40% and 60% respectively. Very importantly, the total number of children affected by growth stunting, which is caused by long-term chronic malnutrition, was 27% lower in 2020 than in 2000. This is all important evidence of the value of development co-operation and global leadership, North and South.
All of us in this room need to ensure that as we take on the current challenges, we do not lose sight of or let the public lose confidence in the value of solidarity, partnership and humanitarian action. We all know, however, that the polycrisis elements of Covid-19, climate change and conflict are combining to pose an unprecedented threat to this progress. Covid-19 has wreaked havoc on health systems across the world and an estimated 14 million people have died due to its direct and indirect effects. Additionally, every region across the globe is experiencing weather and climate extremes. If current trends continue, the UN Office for Disaster Risk Reduction projects that medium- to large-scale disasters could reach 560 annually, an average of one-and-a-half per day, by 2030, which is a 40% increase on 2015.
Conflict is also affecting more countries, people and communities than ever before. There are almost 2 billion people now living in conflict-affected countries. The world is today witnessing the largest number of violent conflicts since the Second World War, and a record 100 million people are forcibly displaced worldwide.
As Ms McKenna mentioned, total external debt stacks of lower and middle-income countries rose by 5.3% in 2022 to $8.7 billion. Countries in sub-Saharan Africa have seen the most pronounced deterioration in debt indicators. The ratio of debt to gross national income rose from an average of 23% in 2011 to 44% in 2020 for those countries. The average debt-to-export ratio tripled over the same period.
What does this all mean on the ground for communities for whom GOAL and other agencies work? First, the steady progress on poverty reduction over the past 25 years has been reversed, increasing sharply between 2019 and 2020, from 8.3% to 9.2%. This was the first rise in extreme poverty since 1998 and the largest increase since 1990, erasing more than four years of steady gains. The progress on zero hunger has also been halted. In 2021, 150 million more people faced hunger than in 2019, and 350 million more people lacked regular access to adequate food in 2021 since the beginning of the pandemic. Today, a shocking one in ten people worldwide is suffering from hunger. The progress on good health and well-being, which is sustainable development goal No. 4, is equally negatively impacted as disruptions to health services caused by the pandemic affected maternal and children's health, immunisation rates, mental health programmes, and treatment of diseases such as HIV, hepatitis, TB and malaria. There are 22.7 million children who missed basic vaccines in 2020, which is almost four million more than in 2019.
Tragically, progress on gender equality is simply abysmal. The world is not on track to achieve its goals on gender equality by 2030, and the social and economic fallout from the pandemic has made the situation even bleaker. Progress in many areas, including time spent on unpaid care, domestic work, decision-making regarding sexual and reproductive health, and gender-responsive budgeting, has been eroded. Women's health services, already poorly funded, faced major disruptions. Violence against women remains endemic. Despite women's leadership in responding to Covid-19, they still trail men in securing the decision-making positions they deserve.
Ireland has a really significant opportunity as the co-chair of the sustainable development goals summit to lead and revitalise global co-operation on the sustainable development goals, SDGs. I will make four recommendations in support of this revitalisation effort. First, as part of its globalisation approach, we recommend that Ireland launch a specific fund dedicated to strengthening locally led initiatives in the global south focused on tackling gender-based violence, women's rights and women's health, all of which remain severely underfunded despite global commitments to gender equality. Second, while climate finance provided by developed countries totalled almost $80 billion in 2019, it is actually estimated that what is needed is $1.6 trillion to $3.8 trillion each year through to 2050 for the world to transition to our low-carbon future. Ireland's stated commitment and leadership on climate finance is welcome. We urge the Government to continue to increase its contributions to the global south beyond 2025, including increased financing for the new loss and damage fund.
We also note it is important Ireland closes its own implementation gap between its ambition and its action on climate change. Despite having committed to a 51% reduction in emissions by 2030, the Environmental Protection Agency data show that Ireland's emissions increased by 4.7% in 2021. We urge Ireland to reduce polluting emissions across all sectors and the phasing out of all fossil fuels in accordance with the Paris Agreement commitments and national climate action legislation.
Third, we recommend the end of the catastrophic out-of-pocket health expenditure for resource-poor families. Ireland must deliver on political commitments at the 2023 UN high-level meeting on universal health coverage this September to reinvigorate progress towards delivering health for all, which is significantly off track in achieving its target of coverage for 1 billion additional people by 2030.
Finally, at this week's financing for development forum and at future forums, we urge the Minister for Finance to push for debt cancellation for sub-Saharan African countries rather than ongoing debt rescheduling, and to ensure the International Monetary Fund, IMF, post-Covid austerity measures do not erode local social protection and universal healthcare measures.
We are in unprecedented times. The assumptions of peace, prosperity and partnership that underpinned the original SDG targets have not held, but we know that global solidarity has worked to reduce poverty and inequality. We need to maintain momentum and public confidence in our efforts. The key to getting the sustainable development goals back on track is ambitious, sustained investment and leadership from the global north, and a deeper than ever commitment to partnership with communities and governments in the global south in the face of this daunting complexity.
