[OPINION] Place health at the core of climate change policy

My colleagues at Medecins Sans Frontieres/Doctors Without Borders (MSF) work in some of the most climate-vulnerable settings in the world, among people who already lack access to basic healthcare or are deliberately excluded from healthcare. The climate crisis is hitting them the hardest. We know because we see them in our waiting rooms more and more frequently. We can see how failures on climate action have ripple effects on healthcare in humanitarian settings.

Adamo Armando Palame, an MSF health promotion supervisor in Mozambique explains it this way: “Those who wonder what climate change looks like should come to Mozambique. We are bearing the brunt of actions by the world’s most polluting countries. We now have malaria all year round and we are struck by cyclone after cyclone.”

Climate change exposes vulnerable people to greater risk of ill health directly – by harm from extreme weather events or disease from vector-borne, water-borne and human-to-human communicable disease – or indirectly, by eroding social and economic coping mechanisms: livelihoods, healthcare systems, water and sanitation. Most-at--risk communities often possess the least adaptive capacities to handle the complex and compounding impacts of climate change while humanitarian responses to amplified needs become more complicated too. In South Sudan, an MSF team observed how unpredictable seasonal patterns and rains forced a usually sedentary community into semi-nomadism for survival, complicating the roll-out of a three round multi-antigen vaccination campaign.

The majority of the 25 countries most vulnerable to climate change and least ready to adapt, are affected by armed conflict. Recent armed conflict analysis by Peace Research Institute Oslo, indicates state-based armed conflict is at its highest level in 30 years. With wars in Burkina Faso, Ethiopia, Gaza, Myanmar, Nigeria, Russia and Ukraine, Somalia, Sudan and Syria, this portends more suffering since conflict instability and the politicisation of healthcare are compounding factors for communities already at risk in climate-driven disasters while they struggle with inadequate infrastructure preparedness and response capacity.

In 2023, Cyclone Mocha – the largest to hit Myanmar in a decade – made landfall in Rakhine state where large numbers of people have been internally displaced due to ongoing conflict and are living in temporary shelters. Before the cyclone hit, thousands of people, were already facing abnormally severe seasonal water shortages. Skin diseases, caused by lack of clean water for washing, already made up 20% of our patient consultations in the dry season. The cyclone damaged essential facilities and the contamination of much of the already limited water supply soon followed. My MSF colleagues prioritised prevention of waterborne diseases, distributing drinking water to 9,000 people per week, and repairing destroyed latrines and water systems. We resumed our activities from before the disaster, including mobile primary health clinics and emergency medical referrals. But the response was a fraction of what was needed and what could have been done. Why?

Weeks after the cyclone hit, travel authorisations were still blocked and then only granted for activities agreed with military authorities prior to the cyclone. They then demanded aid groups hand over relief items to them to distribute, violating both the impartiality and neutrality of aid.

In the last two years alone, my colleagues responded to the impacts of widespread flooding in the Africa’s Sahel region and parts of Asia; severe tropical cyclones in Madagascar and Mozambique, and relentless heat and drought have driven millions to the edge of starvation in Somalia and Ethiopia.

In the same period, we also responded to concurrent cholera outbreaks in 10 plus countries as the impact of poor access to proper water and sanitation and inadequate healthcare infrastructure were catalysed by rising temperatures, intensifying flood and drought cycles. Data from the World Health Organisation indicates that 35 countries had cholera outbreaks in 2023 – 13% more than 2022.

A deadly mix of malaria and malnutrition has kept our paediatric wards full across the Sahel region. In Chad our teams now provide prevention and treatment for malnutrition all year round rather than just seasonally as before.

From Niger to Mozambique, from Honduras to Bangladesh – we treat more patients for malaria and dengue because the vectors of these diseases – mosquitoes – adapt to new environmental conditions and migrate to new locations due to climate change, exposing more people to infection for longer periods. Dengue is the most common and concerning. Over 3.9 billion people are estimated to be exposed to the disease globally today while the number will likely increase by a further billion by 2050, according to WHO.

Dengue is already endemic here in Southeast Asia. MSF has replicated elsewhere some of the success that Indonesia, Malaysia, Thailand, and Vietnam have had trialling innovative vector-control methods. In Honduras, where more than 10,000 cases of dengue are reported annually, the transmission potential has increased significantly and MSF teams responded to seven outbreaks in 14 years.

Traditional chemical vector-control methods are less effective now; mosquitoes have become resistant to them. Last year, MSF and the Honduran Ministry of Health launched new vector-control studies, including a Wolbachia method pilot like one done in Singapore and Southeast Asia. The mosquito population of a district of Tegucigalpa is being replaced with mosquitoes inoculated with the Wolbachia bacteria that blocks dengue viruses from replicating, thereby cutting transmission. In previous studies conducted in other endemic settings, Wolbachia was proven to reduce dengue transmission by up to 95%. The method appears to be environmentally safe, self-sustaining, and cost-effective.

I hope that trialling practical solutions in Southeast Asia in ways that humanitarian groups like MSF can replicate elsewhere in the world, becomes a feature of the emerging future humanitarian landscape. This region can be a source of solutions for other places where institutions are sometimes less strong or reliable. That would be an excellent expression of solidarity via concrete action.

Other steps should include, producing and sharing knowledge to fill gaps. An MSF review of the latest assessment reports by the authoritative Intergovernmental Panel on Climate Change highlighted that meningitis, snakebite, leishmaniasis, measles, Ebola, and human African trypanosomiasis – all climate sensitive diseases and humanitarian health problems – were underreported or absent in the latest edition.

While health doesn’t yet feature prominently in international decision-making processes, it urgently needs to be at the centre of all multilateral climate negotiations, policies, commitments, and action. This means bringing health organisations and stakeholders to the negotiating table. Here too the Southeast Asia can play a significant role.

Finally, coherence on planning for, and responding to climate health emergencies is essential since efforts still often remain siloed, with little coordination and coherence across sectors – perhaps most of all, in terms of funding. A key focus of COP29 will fall on finance and we already see some countries choosing to cut humanitarian funding and divert that money to climate programming. This cannot be. Coherent climate action must fill gaps and enhance humanitarian and development assistance, not be set up to compete with it.

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Christopher Lockyear is the Secretary General of International Medical Humanitarian Organisation Medecins Sans Frontieres/Doctors Without Borders.