It started with a cough. Polly Melville was 14 years old, an athletic schoolgirl living just outside Tain in the Scottish Highlands. She had always felt fit and healthy, but was now struggling to fight off what seemed like a chest infection. She lost weight. Her lymph glands were terribly swollen. After months of tests, she was given a devastating diagnosis: she had Hodgkin lymphoma, a type of cancer.

For four-year-old James, it began in April last year, with a headache. Within a month, the pain was so bad that he was punching his head to make it go away. His GP thought it might be childhood migraines. Then scans revealed a large brain tumour at the back of his skull. A neurosurgeon explained to James that there was a black ball in his head, and they were going to take it out. “So I won’t have a sore head any more?” his mother, Lynne, recalls him asking. “Oh yes, high five!”

Polly’s cancer, which she and her sisters came to call “Mr Hodgkin”, went into remission after six months of chemotherapy. Slowly, she felt better. But then it returned. She needed more chemo, and this time it would be more aggressive. So aggressive, in fact, that her doctors expected it to leave her infertile. She was likely to go into menopause soon after her treatment, experiencing the hormonal changes, hot flushes and chronic pain that women usually confront in their 50s.

James also needed more treatment. First radiotherapy: five days a week for six weeks, each time under full anaesthetic. Then chemotherapy. “I’m going to cover you with my hair!” he joked to his sisters. When all that was over, there would be another side-effect. Like Polly, he was likely to be infertile.

The hope of conceiving a child some decades from now may seem insignificant compared with the immediate challenge of surviving a terrible disease. But it is precisely because doctors have become so much better at treating children with cancer that they are paying more attention to the future. In the 1970s, only about a third of children survived the disease beyond 10 years. Now it is roughly three-quarters, and the rate keeps improving. The five-year survival rate, which reflects the most recent advances in treatment, is more than 80%.

Now, we expect to cure 90% of children with leukaemia. That’s happened in our lifetime

Prof Hamish Wallace, a paediatric oncologist in Edinburgh, has witnessed the huge change in his field. On a bright summer morning, we meet in the cosy old townhouse by the Meadows, where he has been treating children with cancer since the 1990s. There are flowering shrubs outside and a football table in the waiting room. A nappy-changing table in the corridor is a reminder of just how young some of his patients are. In his office, stuffed toys are piled up by the examining bed, and the walls are covered with photos of his former patients celebrating life’s milestones: smiling children on holiday, proud graduates in black gowns, happy couples on their wedding day.

Wallace recalls a time when the outlook for these young patients would have been grim. Take leukaemia, he says, the most common type of childhood cancer. In the 1960s, when he was a little boy in Edinburgh, there was no hope: “You’d have brought a pale child with bruising, bleeding and maybe infection to the hospital, they’d have a blood test and a bone marrow test, a diagnosis of leukaemia would be made, and the only treatment available at the time was a metal canula and a blood transfusion. And it was considered to be a death sentence.” He shakes his head in wonder. “Now, we expect to cure 90% of children with leukaemia. That’s happened in our lifetime. It’s amazing.”

But as more and more children and teenagers recovered, doctors were faced with a new challenge. They saw children who bravely endured chemotherapy, radiotherapy and multiple surgeries, only to be crushed by the long-term side-effects. One of them was infertility. Certain types of chemotherapy can kill eggs, sperm and even the so-called germ cells in a little boy’s testicles that would later develop into sperm. Radiotherapy can indirectly affect fertility by disrupting hormone production. It can also damage the ovaries, womb and testicles.

“Just to cure children isn’t enough,” Wallace says. “If you cure them and they are stunted in growth, intellectually not achieving their potential, and infertile, then perhaps you haven’t achieved enough.” Earlier this year, a study he co-authored showed that women who have survived cancer are 38% less likely to become pregnant compared to the general population.

“I’ve looked after children who were successfully being cured, and then I’ve witnessed what happens in their teenage years when they then go through premature ovarian failure,” says Dr Sheila Lane, a paediatric oncologist at the John Radcliffe hospital in Oxford. “Suddenly their cancer now lives with them for ever.”

As she shows me around the sprawling hospital complex where she works, Lane describes the damage that infertility can inflict on a young person. I later hear what she tells me echoed by several survivors: the fear that nobody will love them, the feeling of being somehow deficient. Infertility can be difficult at any age, but for someone who is only just starting to discover themselves and form relationships, it can be devastating. Lane decided she had to help. In 2013, she and her colleagues set up a service in Oxford offering fertility preservation for young patients. This new, fast-evolving science uses cryopreservation – the process of freezing tissue – to enable a person to have children in the future.

Adults threatened with infertility from cancer treatment can freeze eggs or sperm if there is time and their hospital offers it. But how do you save the future fertility of a child, or even a baby? A girl has all the eggs she will ever have by the time she is born, but those eggs are immature. And little boys do not yet produce any sperm.

A team of scientists in Edinburgh found the solution, or at least part of it, in the 1990s. Instead of having to harvest individual, mature eggs, you could freeze an entire piece of ovary with all the eggs in it, stitch it back later, and hope it would spring back to life. They tried this in sheep, and it worked: the result was a healthy little lamb called Elmar.

“People had done some crazy ovarian transplants over the years, going back a hundred years, actually,” says Prof Richard Anderson at the University of Edinburgh, who helped set up the pioneering fertility preservation service there. “But [the Edinburgh team] really thought that this would be something that could be done for cancer patients.”

The team started freezing ovarian tissue from adult women, teenagers, children, and even babies. The tissue is collected while the patient is under general anaesthetic. If possible, this is combined with a procedure that is part of the cancer treatment, such as a biopsy. In the case of girls and women, either a piece of the ovary or one whole ovary is removed through keyhole surgery. The ovary’s outermost layer, which contains the eggs, is then cut into strips, frozen and stored at about -170C using liquid nitrogen vapour.

Around the world, other scientists did the same, freezing and storing tissue from adults and children. And then, in the 2000s, they began to transplant it back.

***

Sara Matthews, a consultant gynaecologist at the private Portland Hospital for Women and Children in London, still remembers the day about three years ago when a young woman called Moaza Al Matrooshi walked through her door. At first, her story sounded like that of many other women: she had recently married, and was struggling to conceive. But when Matthews leafed through Moaza’s medical history, she noticed something unusual. At the age of nine, Moaza had undergone chemotherapy as part of her treatment for beta thalassaemia, a blood disorder. Before the treatment, one ovary had been removed, cut into pieces and frozen at the University of Leeds. Moaza was now in her early 20s and undergoing menopause. Her only viable eggs were in that frozen tissue in Leeds. No one had ever reimplanted tissue taken from such a young girl and stored for such a long time: 14 years. But Matthews thought it was worth a try.

Together with specialist surgeons in Denmark, Matthews stitched the preserved tissue back into place, a procedure she describes as straightforward. They removed the skin from Moaza’s remaining ovary, made “a little patchwork quilt of new pieces where the old skin was”, and tucked the remaining pieces into the fold of tissue where the other ovary had been, “like a little sandwich”.

A young girl’s – and indeed a baby’s – ovaries contain hundreds of thousands of eggs. So there was a good chance that the tissue would work as well as, or even better than, tissue from older patients whose reserve has already declined. Nevertheless, what Matthews was doing was unprecedented, and she knew that she and her patient would attract global attention.

“I said to her, ‘We’re going be on the news, if this is going to work… Are you OK with that? Because this means so much to so many little girls.’” Matthews’ voice breaks as she says this, and she stops. “Sorry, I get very emotional about these things.”

A few months after the operation, both the little patchwork and the little sandwich were producing eggs. The frozen pieces had sprung to life again. The eggs were fertilised through IVF, and one of the resulting embryos grew in Moaza’s womb. Nine months later, she gave birth to a healthy baby boy. As Matthews had predicted, the birth made headlines around the world. It remains an extraordinary case. More than a hundred babies have been born from ovarian transplants worldwide. But Moaza is still the only person in the world to have had a baby from tissue collected before puberty.

***

For Polly Melville, saving her fertility was the last thing on her mind as she faced a new round of treatment. But her mother, Susie, worried about it. “For her to deal with that knowing she would never give birth to her own child was just so cruel.” Polly’s sisters joked that they could have a baby for her, and they all giggled about it. Susie feared that the reality would be more painful.

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His views were echoed by Hans Joachim Schellnhuber, a professor of theoretical physics and founder of the Potsdam Institute for Climate Impact Research in Germany. He said his recent Hothouse Earth report , which was one of the most widely quoted and downloaded studies of this year, had helped to change the language used to describe the climate crisis.

“Global warming doesn’t capture the scale of destruction. Speaking of hothouse Earth is legitimate,” he said.

The scientists expressed frustration at the slow pace of action by political leaders. In signing the 2015 Paris agreement, governments around the world aimed to keep global warming to within 1.5C to 2C above pre-industrial levels. But current commitments are far off track.

The Met Office upgraded its forecasts this week to show the planet is on track to warm by between 2.5C and 4.5C. “We have broadened out the range of possibilities,” said Betts, who is conducting a risk assessment based on the new projections. In the UK, he said the trend was towards wetter winters with more floods, hotter summers with more droughts interspersed with increasingly intense rain.

At 3C of change, Schellnhuber said southern Spain would become part of the Sahara. Even 2C, he said, could not be guaranteed as safe.

Water lines on the step banks of Algeciras reservoir in Librilla, Spain. Photograph: David Ramos/Getty ImagesThe Paris pact was a firewall, he said. “It’s not helping us to keep the world as it is now. We’ve lost this opportunity already. It’s a firewall against climate chaos.”

Johan Rockström, executive director of the Stockholm Resilience Centre, said “cracks” were starting to appear in the climate system that were pushing nature from being a friend that absorbs carbon dioxide to an enemy that releases carbon dioxide. These concerns are fuelled by the growing intensity of forest fires, the effect of melting ice-sheets on the jet stream, and the rising risk of permafrost thaw, which would release trapped methane.

Although he stressed it might not yet have passed a tipping point, he said the warnings were getting louder. “This shift from friend to foe is no doubt a scientific nightmare. That is the biggest worry that we have,” he said. “It does terrify me. The only reason we sit here without being completely depressed is that we see we have policy measures and technology to move in the right direction.

“We need to have a diagnosis just like a patient who comes to a doctor and gets a really bad diagnosis. But if the science is right, the technology is right, and the policy is right you can cure that very dire situation. There is no scientific suggestion that the door is shut.”

This week’s climate talks have crept forward with only small progress towards a new global rulebook, but emissions continue to rise and the planet continues to heat.

“Things are obviously proceeding very slowly,” said Betts. “As a scientist, it’s frustrating to see we’re still at the point when temperatures are going up and emissions are going up. I’ve been in this for 25 years. I hoped we’d be beyond here by now.”

Schellnhuber concurred. “I’ve worked on this for 30 years and I’ve never been as worried as I am today.”

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The school climate strike was a new generation’s activism – and I’m so proud

Naaman Zhou

I count myself as nearly of the same generation as the strikers. I’m six years out of high school, nearly graduated from university – but I’ve never seen a protest like this.

I came in with cynicism. In the exact same spot, I have seen so many protests wither on the vine, outnumbered by food-court patrons.

University students like to think that they are the epicentre of social change, or at least they were in the heyday of the 70s. But on Friday in Sydney all you could hear in the CBD were the school kids, and in Melbourne they stopped traffic at 1pm on a school day.

Activism seems to have skipped a generation, and I couldn’t be happier.

In Sydney, Jean Hinchliffe, 14, had the stage and took the roll, in a way. She asked who here was in primary school, who was in high school, who was from western Sydney, who had travelled from the bush, who wanted their politicians to do way more about climate change. The roar sent the microphones screaming into static and camera operators winced with their headphones in.

Scott Morrison had told them not to gather and that only made them feel better about doing it. Finally, something the politicians couldn’t control. That was the theme of the day – the frustration of feeling powerless.

“You have failed us all so terribly,” said Nosrat Fareha, 15, from Auburn Girls High school.

“We deserve better. Young people can’t even vote but will have to live with the consequences of your inaction for decades.”

Morrison was mentioned by every speaker and booed every time. How much he must regret that throwaway line in question time, that “kids should go to school” and be “less activist”, and the electoral harm it threatens to cause in a few more years.

It was so easily turned around, and the irony obvious to all. “If Scott Morrison wants children to stop acting like a parliament, then maybe the parliament should stop acting like children,” Manjot Kaur, 17, said.

It was an articulate anger, and the speakers made sure to say they had the solutions too, not just the doom and gloom. There was music and happiness. They sang Stand by Me and everyone knew the words – an old-school activist vibe to make anyone dewy-eyed. One girl said to another, “Oh I should have put you up on my shoulders for that!” and then did on the next song.

“Here’s to us”, said Fareha. “The generation that can’t wait until it’s too late”.

There will inevitably be blowback from the rightwing commentariat, and the politicians themselves, that these young activists have been whipped into a false frenzy. But that’s not what this was. It was a hesitant, cautious embrace of something long overdue.

“When I say student, you say power!” Hinchliffe shouted. They did. And it felt like a sense of self-actualisation – hundreds looking around and thinking yes, everyone is actually, really saying it too. Maybe it’s true. The call and response came up and down Martin Place in waves, swimming long laps. They were clutching their ears it was so loud.

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