AS leaders gather for the 29th Climate Conference (COP29) in Azerbaijan, they must face the reality that the climate crisis is also a health crisis for millions of the most vulnerable people on our increasingly warmer planet.
To respond effectively, it is crucial to place health at the centre of discussions, policies and funding decisions while also drawing lessons from insights in Southeast Asia.
My colleagues at Medecins Sans Frontieres/Doctors Without Borders (MSF) work in some of the most climate-vulnerable regions, serving populations who already lack access to basic healthcare or are deliberately excluded from it.
The climate crisis is hitting them the hardest. We see this firsthand, with more and more people seeking care in our clinics. We can see how failures in climate action are creating ripple effects that are worsening healthcare outcomes 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 increases the risk of illnesses for vulnerable populations, both directly – through harm from extreme weather events or the spread of vector-borne, waterborne and human-to-human communicable diseases – and indirectly, by eroding social and economic coping mechanisms such as livelihoods, healthcare systems and access to water and sanitation.
Communities most at risk often have the least capacity to adapt to the complex and compounding impacts of climate change while humanitarian responses to their growing needs become increasingly challenging.
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 multiantigen vaccination campaign.
Most of the 25 countries most vulnerable to climate change and least equipped to adapt are also affected by armed conflict.
Recent analysis by the Peace Research Institute Oslo shows that state-based armed conflict is at its highest level in 30 years. With ongoing wars in Burkina Faso, Ethiopia, Gaza, Myanmar, Nigeria, Russia and Ukraine, Somalia, Sudan and Syria, this portends more suffering.
Conflict instability and the politicisation of healthcare are compounding factors for communities already at risk from climate-driven disasters, as they struggle with inadequate infrastructure and limited preparedness and response capacity.
In 2023, Cyclone Mocha – the largest to hit Myanmar in a decade – made landfall in Rakhine state, where many people have been internally displaced by ongoing conflict and are living in temporary shelters.
Before the cyclone hit, thousands of people were already grappling with severe seasonal water shortages. Skin diseases, caused by lack of clean water for washing, accounted for 20% of our patient consultations during the dry season.
The cyclone damaged essential infrastructure, and the contamination of the already limited water supply quickly followed.
My MSF colleagues prioritised preventing waterborne diseases, distributing drinking water to 9,000 people per week and repairing damaged latrines and water systems.
We also resumed our pre-disaster activities, including mobile primary health clinics and emergency medical referrals. But the response was only a fraction of what was needed and what could have been done. Why?
Weeks after the cyclone, travel authorisations were still blocked, and when they were eventually granted, they were limited to activities pre-approved by military authorities.
The military then demanded that aid groups hand over relief supplies for their own distribution, violating the principles of impartiality and neutrality in humanitarian assistance.
In the past two years alone, my colleagues have responded to widespread flooding in Africa’s Sahel region and parts of Asia, severe tropical cyclones in Madagascar and Mozambique, and relentless heat and drought that have pushed millions to the brink of starvation in Somalia and Ethiopia.
During the same period, we also responded to concurrent cholera outbreaks in more than 10 countries where poor access to clean water, inadequate sanitation and weak healthcare infrastructure were exacerbated by rising temperatures and intensifying cycles of floods and drought.
According to the World Health Organisation (WHO), 35 countries experienced cholera outbreaks in 2023 –13% more than in 2022.
A deadly combination of malaria and malnutrition has kept our pediatric wards full across the Sahel region. In Chad, our teams now provide year-round prevention and treatment for malnutrition, instead of only during the seasonal peaks as we did before.
From Niger to Mozambique, and from Honduras to Bangladesh, we are treating more patients for malaria and dengue as the vectors of these diseases – mosquitoes – adapt to new environmental conditions and migrate to previously unaffected areas due to climate change. This exposes more people to infection for longer periods.
Dengue is the most common and particularly concerning. Today, over 3.9 billion people are estimated to be at risk, with that number likely to increase by another billion by 2050, according to the WHO.
Dengue is already endemic in Southeast Asia, and MSF has successfully replicated some of the innovative vector-control methods trialled in Indonesia, Malaysia, Thailand and Vietnam in other regions.
In Honduras, where more than 10,000 cases of dengue are reported annually, the transmission potential has increased significantly, and MSF teams have responded to seven outbreaks in the past 14 years.
Traditional chemical vector-control methods are less effective now; mosquitoes have become resistant to them.
Last year, MSF and the Honduran Health Ministry launched new vector-control studies, including a pilot of the Wolbachia method, similar to those conducted in Singapore and Southeast Asia. The mosquito population in a district of Tegucigalpa is being replaced with mosquitoes inoculated with the Wolbachia bacteria that blocks dengue viruses from replicating and helps reduce transmission.
Previous studies in other endemic areas have shown that Wolbachia can 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, becomes a hallmark of the future humanitarian landscape. This region has the potential to offer solutions for areas where institutions are often weaker or less reliable. Such efforts would be a powerful expression of solidarity through 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 under-reported or absent in the latest edition.
While health does not 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. Southeast Asia can also 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 should not be.
Coherent climate action must fill gaps
and enhance humanitarian and development assistance, not be set up to compete with it.
Christopher Lockyear is the secretary general of international medical humanitarian organisation Medecins Sans Frontieres/Doctors Without Borders. Comments: letters@thesundaily.com
